Application | Jews of East Village

JoEV Afterschool

Application Form 2026-2027 School Year

Guardian Information

Parent/Guardian - One

Parent First name

Parent Last name

Email

Phone Number

Parent/Guardian - Two

First Name

Last Name

Email

Phone Number

Religious Affiliation

Mom's Jewish

Dad's Jewish

Both Parents Jewish

Multi-line address

Country/Region

Address

City

Zip / Postal code

Child Information

Child First name

Child Last name

Birthday

Month

Day

Year

Grade attending

School attending

Does your child require School pick up?

Who will be picking up your child from JoEV center?

*Any known allergies (incl. reactions to medications) and any present medical conditions?

No

Yes

We would love to get to know you & your child a bit more:

Tell us about your Family.

How did you hear about JoEV Afterschool

Please upload a picture of your Child

What would you LOVE for your child to gain at JoEV afterschool?

Which Days Will You Child Be Joining:

Monday

Fall Semester

Spring Semester

Wednesday

Fall Semester

Spring Semester

Full Year: Monday & Wednesday

Yes

Tuition:

One Day:

Semester: Full Amount $1,200

Full Year: Full Amount $2,200

Two Days:

Semester: Full Amount $2,200

Full Year: Full Amount $4,000

Discount Special (Enter Custom Amount)

Tuition:

$

*As the parent/guardian of the above child/ren, I authorize any staff member of person acting on behalf of JoEV Afterschool to administer first aid, hospitalize or secure treatment for my child. JoEV will make every effort to reach a parent/ legal guardian, and will use the authorization of this form when time and circumstance doesn’t allow for waiting to contact a parent. I agree to pay all charges associated with care and/or treatment.

*I grant permission to JoEV Afterschool, its employees and representatives to use images of my child taken in conjunction with JoEV Afterschool for publications such as electronic material, newsletters, social media outlets, and advertising.

Please reach out to the office if financial assistance is necessary - we are excited to hear from you!

JoEV Afterschool is a subsidiary program of Jews of East Village - Chabad. [Chabad East Village NYC Inc]

Parent/Guardian Signature

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