Program Registration Form

Program Registration Form
Choose your Campus:*

1650 Elgin Mills Road East66 Cathedral High Street11685 Yonge Street
Student(s) Information
First Child*

First NameLast Name
Second Child

First NameLast Name
First Child's Birthday*

MonthDayYear
Date
Second Child's Birthday

MonthDayYear
Date
Current School*
Grade in Sept 2026 (First child)*
Grade in Sept 2026 (Second child)
Allergies*
input n/a for none
Special Medical, Physical or Emotional Needs that our teachers should be made aware of.
Parent Information
Parent Name*

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

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Consent*

I agree to receive e-mails from JEI Learning Center containing information regarding JEI Learning Center’s promotions. I can withdraw my consent at any time. (Please refer to our Privacy Policy or contact us for more details.)
Emergency Contact Information (Other than parent) - if applicable
Emergency Contact Name

First NameLast Name
Phone Number
Format: (000) 000-0000.
Relationship
Authorized for pick-up

YesNo
Program(s) of interest - please choose the specific program for which you wish to receive information.
JEI Subject Programs (Weekly Class)

JEI English (JK-Grade 3)JEI Reading & Writing (Grade 3-8)JEI Math (JK-Grade 8)Subject Evaluation
After School Club (JK-Grade 6)

5 days program4 days programShuttle School Pick-up required
Smart Saturday Pass 10am-12pm (JK-Grade 3) *Choose two subjects

JEI English ClassJEI Math ClassJEI Brain Safari Class
PA Day Camp 9am-3pm, Pizza included | Extended hours 3-5pm $15/day

Friday, Jun 5, 2026 (Flower Power)Friday, Jun 26, 2026 (Seaside Escape)Daily Rate $95.00 (9am-3pm includes pizza)
March Break Camp Starry Skies & Ocean Eyes (JK-Grade 4) ONLY AT ELGIN MILLS

March 16-20, 2026, 9am-3pm $495.00Includes One JEI Workbook 9am-5pm $565.00Daily Rate 9am-3pm $100.00/childAdd-on Lunch Meal $20/day
Summer Learning Club Drop-in Program July-August
Choose your subject(s) and your Pass option
Cathedraltown Summer Camp (Ages 4-8 only)

Week 1: July 13-17Week 2: July 20-24Week 3: July 27-31Week 4: August 10-14Week 5: August 17-21Week 6: August 24-28LIMITED TIME OFFER $299/week 9am-3pm (B1G1 50% OFF)Add extended 3-5pm $75/week (One JEI Workbook Program)Add extended 3-5pm $90/week (Two JEI Workbook Program)
Summer Camp (JK-Grade 4) 9am-3pm at Elgin Mills / North Richmond Hill Campuses

Week 1: July 6-10Week 2: July 13-17Week 3: July 20-24Week 4: August 10-14Week 5: August 17-21Week 6: August 24-28All 6 weeks $430/week + FREE LUNCHSign up 3 to 5 weeks $440/week + FREE LUNCHEarly Bird $450/week + FREE LUNCHAdd-on 8am drop-off $40/weekAdd-on 3-4pm PROMO $75/week (One JEI Program)Add-on 3-5pm PROMO $145/week (Two JEI Programs)Standard Lunch Plan $85/week (4 days)
Comments
Terms & Conditions
Please click yes if you WILL give permission to have photographs taken of your child*

YesNo
We occasionally take pictures of the kids in action with the materials or doing other activities for our website, and various Social Media platforms. We hope to use these to keep parents up to date on the happenings at the center.
How did you find us?*
If you were referred by a friend please let us know who, so we can thank them!
Parent Signature*
Enter the message as it's shown*
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 program information packet and payment link. Thank you for your attention.
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