Summer Programs Registration Form

JEI Summer Programs Registration

Start Next Year Strong with JEI Summer Programs
Student(s) Information
First Child*

First NameLast Name
Second Child

First NameLast Name
First Child's Birthday*

MonthDayYear
Second Child's Birthday

MonthDayYear
First Child's School
Second Child's School (leave blank if same as the first child)
Grade in 2025 Fall (1st Child)*
Grade in 2025 Fall (2nd Child)
Allergies:
Special Medical, Physical or Emotional Needs that our teachers should be made aware of.
Parent/Guardian Information
Parent's Name*

First NameLast Name
Cell Number*
Format: (000) 000-0000.
E-mail*
example@example.com
Home Address*

Street Address

CityState / Province

Postal / Zip Code
Emergency Contact Information (Other than parent) - if applicable
Emergency Contact's Name

First NameLast Name
Phone Number
Format: (000) 000-0000.
Relationship to child
Authorized for pickup

YesNo
Please choose the program/week(s) for which you'd like to enroll your child:
ONE SUBJECT | MON - THUR | 3:30-4:30 PM or 4:30-5:30 PM

Week 1 - June 16 - 19Week 2 - June 23 - 26Week 3 - July 7 - 10Week 4 - July 14 - 17Week 5 - July 21 - 24Week 6 - July 28 - 31Week 7 - August 4 - 7
TWO SUBJECTS | MON - THUR | 3:30-5:30 PM (2-hour option not available for students raising to grade K in 2025 fall.)

Week 1 - June 16 - 19Week 2 - June 23 - 26Week 3 - July 7 - 10Week 4 - July 14 - 17Week 5 - July 21 - 24Week 6 - July 28 - 31Week 7 - August 4 - 7
Program Fees

One Hour/One Subject Program $140/wk

Two hours/Two Subjects Program $250/wk
IMPORTANT:

This form simply accepts your registration information. It is not a confirmation of guaranteed enrollment, as spaces in our class and camp programs are limited. We will contact you within two business days to communicate if your desired session is available. If it is, we will formally confirm your registration and send you the payment link.
Signature
Should be Empty:

JEI Summer Programs Registration

Student(s) Information