Request More Info - Childcare (K-10th Grade)

Request More Info

Summer Camp | After-School Care | Enrichment Programs | School Break Programs
Please use this form to request more information about our childcare programs and someone will reach out. If this is a time sensitive question, please call us at 610-435-3571.
Your Name*

First NameLast Name
Email*
E-mail
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Phone Number
OptionalFormat: (000) 000-0000.
Which programs are you interested in? (Select all that apply)*

Summer Camp (Ages 4-14)JLounge Afterschool Program (Grades K-5)Afterschool Enrichments (Grades K-8)School Break Programs (Grades K-5)
Number of Children*

1234
Child Grades (as of 9/1)*

Under 4 YearsPre-K/Kindergarten1st/2nd3rd/4th5th/6th7th/8th9th/10th
Child 1 Birthdate

MonthDayYear
Date
Child 2 Birthdate

MonthDayYear
Date
Child 3 Birthdate

MonthDayYear
Date
Child 4 Birthdate

MonthDayYear
Date
Department/Topic
Would You Like to Schedule a Tour?

YesNo
What Days Work Best For You?

MondayTuesdayWednesdayThursdayFriday
Preferred Time(s)

Morning (8am-11am)Midday (11am-1pm)Afternoon (1pm-4pm)
Your Message
How did you hear about us?*

Google SearchFrom a Friend/FamilyLocal/Drove ByAttended a JCC Program/EventFacebookOther
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