Youth Form

Youth Department Registration
If you would like to register more than one child, please submit a new form for each additional child.
Kids Hip Hop Class

Wednesdays, 4-5PM

Bernikow Building

October: 10/7, 10/14, 10/21, 10/28

November: 11/4, 11/11, 11/18, 11/25

December: 12/2, 12/9, 12/16, 12/23

January:1/6, 1/13, 1/20, 1/27

$50 per month (4 classes)
Early Bird: $180 for full course
Due by August 12
16 Classes in 4 months

Camp Nights

For kids ages 3+

Please pack a bathing suit and towel. *All children must be potty trained

Starting October 17
Select Saturdays, monthly

7:00PM-9:30PM

Bernikow JCC, 1466 Manor Road

FREE for JCC Members, 2026 campers, and students in the JCC's Early Childhood programs

Non-members $25

Monkey Bars & Mitzvot!
November 8, 10:00AM-11:30AM
Bernikow JCC
$8 per JCC Members, students in the JCC's Early Childhood programs & 2026 Campers
$12 per Non-Member child
This is a family event. Adults must remain to supervise children.

Join us for a fun-filled day of animals, play, and giving back!
Meet exotic animals from Wild Side Zoo, explore the playground, and take part in a special mitzvah project by making dog toys to donate to animals in need!
The only memberships eligible for the member discounts for ‘Youth programming registrations’ are WellPro & Program – Family or Head of Household memberships.

A couple’s or an individual’s membership does NOT entitle their children to the discount.

The JCC of Staten Island is thrilled to partner with PJ Library to offer the gift of free Jewish storybooks to families raising Jewish children. Each child, from newborn to 12 years old, is eligible to receive their own age-appropriate Jewish-themed book in the mail every month. Is this program a fit for your family?
Language
Child first and last name (For PJ Library book envelope)

First NameLast Name
Child date of birth (For accurate PJ Library book age category)
How did you hear about PJ Library?
If you'd like to enroll a second child for PJ Library, please provide their name & date of birth

Events

October 17- Camp Night

FREE program for JCC Members, ECE Children & 2026 Campers

$25.00 QuantityMembership

11/8 Monkey Bars & Mitzvot!

Discounted rates for JCC Members, ECE Children & 2026 Campers

$12.00 Quantity

Total

Credit Card

First Name

Last Name

Credit Card Number

Security Code

Expiration Month

Expiration Year

Billing Address

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Country

Parent Name

First NameLast Name
Home Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Cell / Work Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Child's Name

First NameLast Name
Child's Date of Birth

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Child's Grade
Is your child currently enrolled in the JCC’s Camp programs?
Is your child a JCC Early Childhood student?
What building does your child attend?
Child's Names and Ages
Does your child(ren) have any health concerns, special considerations, and/or allergies?
Emergency Contact Name

First NameLast Name
Relation to Child
Emergency Contact Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
I hereby authorize emergency medical treatment of my child in the event that I can not be reached. I hereby grant permission to the Jewish Community Center of Staten Island to use photographs and/or video of me in publications, news releases, online, and in other communications related to the mission of the JCC.
I hereby grant permission for my child to be included in photographs or videos for JCC publicity. I release all rights to such photographs and videos.
I hereby grant my child permission to participate in swim at the JCC Indoor Pool
I understand that the JCC reserves the right to remove my child(ren) from the program, if in the opinion of JCC staff my child(ren)’s behavior prohibits their safe and successful participation in the SCHOOL'S OUT program. The JCC will not tolerate any behavior which is emotionally and/or physically harmful to a child or staff member.
PHOTO POLICY:

When you enter a JCC of Staten Island event or program, you enter an area where photography, audio, and video recording may occur.

By entering the event premises, you consent to interview(s), photography, audio recording, video recording, and its/their release, publication, exhibition, or reproduction to be used for news, webcasts, promotional purposes, telecasts, advertising, inclusion on websites, social media, or any other purpose by the JCC and its affiliates and representatives. Images, photos, and/or videos may be used to promote similar JCC events in the future, highlight the event, and exhibit the capabilities of the JCC.

You release the JCC, its officers and employees, and each and all persons involved from any liability connected with the taking, recording, digitizing, or publication and use of interviews, photographs, computer images, video, and/or sound recordings. By entering the event premises, you waive all rights you may have to any claims for payment or royalties in connection with any use, exhibition, streaming, web casting, televising, or other publication of these materials, regardless of the purpose or sponsoring of such use, exhibiting, broadcasting, web casting, or other publication irrespective of whether a fee for admission or sponsorship is charged. You also waive any right to inspect or approve any photo, video, or audio recording taken by the JCC or the person or entity designated to do so by the JCC.

You have been fully informed of your consent, waiver of liability, and release before entering the event.

Should be Empty:

Youth Department Registration

Events*

Events