Just Kids Registration Form 2012-13

Child's Name
Date of Birth (MM/DD/YYYY)
Age (as of 08/2012)
Grade (as of 08/2012)
Desired Enrollment Option (All enrollment options include full days for school closings)
 A: Monday - Friday after school
 B: Monday/Wednesday/Friday after school
 C: Tuesday/Thursday after school
 D: Full Days Only
Name of School
Will you be using Childcare Subsidy Assistance Vouchers?
 Yes
 No
Name(s) of any sibling(s) enrolled in JCC programs
Are you an Asheville JCC member as of May 1, 2012 through April 30, 2013? (if yes, member rates apply)
 Yes
 No
Is anyone in your household Jewish? (optional, for statistical purposes only)
 Yes
 No
Is your household interfaith, i.e., Jewish and non-Jewish parents? (optional, for statistical purposes only)
  Yes
 No
Parent/Guardian #1
Address
City
State
Zip Code
Daytime Phone Number
Cell Phone Number
Email Address
Parent/Guardian #2
Address
City
State
Zip Code
Daytime Phone Number
Cell Phone Number
Email Address

Thank you to our corporate partners! Click on the logos to learn more about them.

  • Blossoms