Early Childhood School & Membership Application (2025-2026)

Early Childhood School and Membership Application

School Year 2025-2026
Dear parents,

It's that time of the year again! Please complete this form to begin the Early Childhood registration process for the 2025-2026 School Year. Please note that registration is on a space-available basis, and that space is not guaranteed until we collect your payment information (if necessary), charge you the required $99 non-refundable deposit, and confirm your registration via e-mail.

To view our calendar, including holidays and closures, for the 2025-2026 school year, please click here.

No children will be admitted to begin school without providing all forms required by the JCC and DHS. These forms are available here or on the JCC website under Early Childhood - Parent Resources.

You must fill out ONE APPLICATION PER CHILD. If you have more than one child, please submit this application and then re-start a new one for each additional child.

For questions about the ECE program and registration, contact Jen Moyer, ECE Director, at jmoyer@lvjcc.org. Or, call us at 610-435-3571 or drop by any time!

We look forward to seeing you and your children for another wonderful school year!

Are you a current member of the JCC of the Lehigh Valley?*

YesNo
Which program will your child attend?*

12 months (June 16, 2025 - June 3, 2026)10 months (August 25, 2025 - June 3, 2026)
Are you a new or returning ECE student?*

New StudentReturning Student
Anticipated Start Date

MonthDayYear
What day to you plan for your child to start school?
Child's Name*

First NameLast Name
Current Classroom*
Gender*

MaleFemaleNon-BinaryOther
Cutoff Date

MonthDayYear
Birthdate*

MonthDayYear
Age as of 9/1/24
This is calculated automatically based on the birthdate above.
Allergies/Special Needs*
If none, please enter "None" in the box.
Does this child have any siblings?*

YesNo
What are their ages? (Check all that apply)

0-12 months12-24 months24-26 months3-4 years5-6 years6-11 years11-14 years14+ years
Home Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Home Phone*

Area CodePhone Number
Family Religion(s)

JewishCatholicMuslimProtestantHinduBuddhistSikhNoneOther
The JCC embraces families of all faiths. This information is used to help us better understand the population that we serve.
Synagogue Affiliation
Parent 1 Name*

First NameLast Name
Parent 1 Birthdate*

MonthDayYear
Date
Relation to Child*
Parent 1 Cell Phone*

Area CodePhone Number
Parent 1 E-mail*
Parent 1 Occupation*
Parent 1 Employer
If there are two parents, do they live together?*

Parents live togetherParents live apartOnly 1 parent
Parent 2 Name

First NameLast Name
Parent 2 Birthdate

MonthDayYear
Date
Relation to Child
Parent 2 Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Parent 2 Cell Phone

Area CodePhone Number
Parent 2 E-mail
Parent 2 Occupation
Parent 2 Employer
What is the relationship between the two parents?

Married/PartnersSeparated/Not MarriedWidowed
Program*

Infants - 6 weeks by 9/1/25Young Toddlers - 12 months by 9/1/25Older Toddler - 2 years by 9/1/25Pre-school - 3 years by 9/1/25Pre-K - 4 years by 9/1/25
Program Hours (Infants)

5 days (Mon-Fri), 7:30am-5:30pm3 days (M/W/F), 7:30am-5:30pm2 days (Tu/Th), 7:30am-5:30pm
Program Hours (Young Toddlers, Older Toddlers, Pre-school)

5 days (Mon-Fri), 8:30am-1pm5 days (Mon-Fri), 7:30am-5:30pm3 days (M/W/F), 8:30am-1pm3 days (M/W/F), 7:30am-5:30pm2 days (Tu/Th), 8:30am-1pm2 days (Tu/Th), 7:30am-5:30pm
Program Hours (Pre-K)

5 days (Mon-Fri), 8:30am-1pm5 days (Mon-Fri), 7:30am-5:30pm
Additional Program Hours

Nap Time, 1-3pmOther
Families are encouraged to participate in our Family Appreciation Fund, which is used to provide holiday gifts, gift cards, meals and events in appreciation of our teachers. By checking this box, I understand my account will be charged $50 per child in December and $50 per child in May for this fund. Participation is optional, and the names of those who choose to participate will be shared with the teachers.
Teacher Appreciation Fund

Yes, please include me in the Teacher Appreciation Fund!
Promotional Code
If given an Promotional Code, enter it here. Otherwise, leave this blank.
Today's Date

MonthDayYear
READ THE FOLLOWING BEFORE SIGNING:

Terms of Use

Membership Agreement

Payment & Refund Policy

Waiver, Release and Indemnification Agreement

Child Care Parent Agreement

Guest Pass Policy
By signing below, I accept the terms of the JCC's Membership Agreement (link above). I understand that I will be charged a monthly membership fee based on my membership type, which will automatically renew each month until I cancel it. Membership fees may change from time and time, with new fees being communicated via e-mail to the address you have provided. To cancel your membership, you can do so in person or on the phone (610-435-3571) during regular business hours, via e-mail (tsussman@lvjcc.org), or via the Daxko online portal. Membership must be canceled with a minimum two (2) business days' notice prior to the next billing date.*
By signing below, I acknowledge that I have read, understand and accept the Terms of Use, Membership Agreement, Payment & Refund Policy, Waiver, Release and Indemnification Agreement, Child Care Parent Agreement, and Guest Pass Policy.*
Are you applying for financial aid?

JCC Financial Aid/Flexible TuitionChild Care Works/ELRC ("Title XX")
Should be Empty:

Early Childhood School and Membership Application