JPlay Interest and Program Deposit - Form - Temple B'nai Abraham

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JPlay Interest and Program Deposit

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* Primary Parent First Name

* Primary Parent Last Name

* Primary Parent Email

* Primary Parent Cell

Parent 2 First Name

Parent 2 Last Name

Parent 2 Email

Parent 2 Cell Phone

Street Address

City

Zip Code

Child's Information

* First Name

* Last Name

Date of Birth

* Please select grade 25-26

T-Shirt Size

Y-XSY-SY-MY-LY-XLA-SA-MA-LA-XL

Gender

Pronouns

How many days will your child be attending?

Which days will your child be attending?

Please specify the days of the week your child will be at JPlay.

What Public School and district does your child attend?

Does your child require any of the following transportation needs to get to JPlay

Booster seat (provided to us prior to JPlay beginning)Car seat (provided to us prior to JPLay beginning)My child does not requireMy child does not require a booster or car seat and is over the age of 8.

Please paste this link into your browser to submit IEP/ 504/ Allergy/ Dietary needs/ Medications for our files.

https://forms.gle/5xC6euGLV6ZJD8fk7

Child's Birthday

* Number of Children Enrolling

A $500 Deposit will be taken for each child you are enrolling. JPlay deposits are non-refundable.

Total to be paid now

Thu, October 30 2025 8 Cheshvan 5786

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Tue, November 19 2024 18 Cheshvan 5785

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