Club J Application
School Year 2017-18

Three great after-school options. For more information about our options, click here. If you're ready to register, please complete the form below.

  1. Club J Afterschool Program + Transportation
  2. Club J Afterschool Program (NO Transportation)
  3. Transportation Only

Parent/Guardian Information

Primary Parent

The Primary Parent provides the primary contact information to receive important phone calls and e-mails regarding his or her child in Club J.

First Name*
Last Name*
Primary Phone?* (XXX-XXX-XXXX)

What type of phone is this?*

Secondary Phone?* (XXX-XXX-XXXX)

What type of phone is this?*

Primary Email*

Parent/Guardian #2

First Name
Last Name
Primary Phone? (XXX-XXX-XXXX)

What type of phone is this?

Email
Marital Status*
 Married
 Separated
 Divorced
 Widowed
 Single
Child(ren) Live(s) With*
What is your relationship to the child(ren)?*
 Parent
 Guardian
For divorced parents or legal guardians, who has legal custody of the child(ren)?*

Participant Information

How did you hear about our program?

Child #1

First Name*
Last Name*
Gender*
 Male
 Female
Date of Birth* (MM/DD/YYYY)
Grade* (as of 9/1/17)
School Attending*
If you chose Other, what school does this child attend? How will they be transported to Club J?
How many days will this child attend?*
Check ALL of the days of the week this child will attend.
 Monday
 Tuesday
 Wednesday
 Thursday
 Friday

Child #2

First Name
Last Name
Gender
 Male
 Female
Date of Birth (MM/DD/YYYY)
Grade (as of 9/1/17)
School Attending
If you chose Other, what school does this child attend? How will they be transported to Club J?
How many days will this child attend?*
Check ALL of the days of the week this child will attend.
 Monday
 Tuesday
 Wednesday
 Thursday
 Friday

Child #3

First Name
Last Name
Gender
 Male
 Female
Date of Birth (MM/DD/YYYY)
Grade (as of 9/1/17)
School Attending
If you chose Other, what school does this child attend? How will they be transported to Club J?
How many days will this child attend?*
Check ALL of the days of the week this child will attend.
 Monday
 Tuesday
 Wednesday
 Thursday
 Friday

Permission & Waiver

Waiver

 I HAVE READ THE MARCUS JEWISH COMMUNITY CENTER OF ATLANTA RELEASE, FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY MY SIGNING IT, AND HAVE SIGNED IT FREELY AND VOLUNTARILY WITHOUT INDUCEMENT, ASSURANCE OR GUARANTEE BEING MADE TO ME AND INTEND MY SIGNATURE TO BE A COMPLETE, CONTINUING AND UNCONDITIONAL RELEASE OF ALL LIABILITY TO THE GREATEST EXTENT OF THE LAW.

Payment

REGISTRATION & DEPOSIT:

There is $50 non-refundable Registration Fee and $150 non-refundable Deposit to be charged at the time of registration.

The Deposit will be applied to your child's May payment. Club J Tuition is billed at an annual rate with equal monthly installments (August - May) for the convenience of a payment plan.

TUITION, REGISTRATION CHANGE & CANCELLATION POLICY

2017-2018 Club J Tuition Rates

All payments (Club J Afterschool Program Tuition & Transportation Only) will be processed on the 17th of each month. If Business Office is closed, payments will be processed on the next business day.

A $25 Registration Change fee will be assessed for each change throughout the year from the original Registration form.

Cancellations must be made before the 1st of the month you wish to cancel. Cancellations made after the 1st of each month will be assessed the rate for the full month tuition.

Please provide the billing address for the credit card or EFT/Bank Account used for Club J fees.

Address*
City*
State*
Zip*
Method of Payment*

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