Parent/Caregiver Registration Form

Parent/Caregiver Registration
Thank you for your interest in attending a JAFCO Parent/Caregiver Event. Please take a moment to fill out the registration form below.
Please select which event(s) you are registering for:
Caregiver Support Groups:
Parent Evening Out:
Parent Education/Behavior Trainings:
Parent/Caregiver Information
Parent/Guardian Full Name
Parent/Guardian Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Parent/Guardian Email
example@example.com
Please list the full names of any additional adults who will be joining you for this event. If you are registering for multiple events, please include the name of the event these adults will be attending:

Permission to Photograph or Videotape
Participant Full Name

First NameLast Name
I, {participantFull}, give permission to be photographed or videotaped and for the photograph(s) and/or video(s) to be used to raise awareness and/or funds to further the mission of JAFCO. Additionally, I understand that these images and videos may be shared on JAFCO's social media accounts to expand community outreach efforts.
This permission is valid until
Signature
Date

MonthDayYear
Date

Childcare
Will you need childcare for the event? (Please note that childcare spots are limited. Requesting childcare is not a guarantee that a spot is available. A staff member will reach out to you directly to confirm if we have open spots for childcare.)
If you registered for multiple events, please specify which events you will need childcare for:
Child(ren) Information
Child(ren)'s Full Name(s) AND Ages
Child(ren)'s Allergies (Ex: food allergies, environmental allergies, medication allergies, etc):
Child(ren)'s Dietary Restrictions (Ex: Gluten free, dairy free, no sugar, Kosher diet, vegetarian, etc)
Does your child(ren) have any medical conditions, concerns, or special considerations? (Ex: seizures, g-tube, asthma, diabetes, eczema, vision impairments, etc)
Please list your child(ren)'s preferred activities and hobbies:
Please list any maladaptive behaviors your child(ren) may engage in and any de-escalation strategies:
Please include any other helpful information about your child(ren) that staff should know about:

Payment Form
Childcare during parent/caregiver events is provided at no cost. Your card will only be charged if you do not attend the event or fail to cancel your childcare reservation at least 24 hours in advance.

If you are unable to attend an event or no longer need childcare, we kindly ask that you cancel your reservation at least 24 hours before the event. Families who do not show up or fail to cancel within this timeframe will incur a $25 no-show fee.

Thank you for your cooperation and understanding!
Photo of Front of Credit Card

Cancelof
Photo of Back of Card

Cancelof
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent Name
Date

MonthDayYear
Date
Please read and check the box below:
Signature
Thank you for your interest in registering for our event(s). If you have any questions, please feel free to reach out to Lilach Karo at lilach@jafco.org

Please click "submit" below to finalize your registration.
Paper Quilling Workshop Registration

Please note that this workshop is limited to the first 12 parents who register.

You will receive a confirmation email notifying you whether you have secured a spot or have been placed on the waiting list.

We look forward to creating with you!
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Parent/Caregiver Registration