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JTeen Learn & Live

THIS IS THE JTEEN LEARN & LIVE REGISTRATION FORM

1. If you are a member, be sure to login first to receive tuition discounts
2. Before filling out and signing this form,
please click here to read and sign the JTeen Learn & Live policies and guidelines

MOTHER'S INFORMATION
FATHER'S INFORMATION
If same as above, write 'same'
If same as above, just write 'same'

TUITION
- Members: Please login to receive the members' tuition discount
1 DAY A WEEK (FRIDAYS) - Members $600; Non-Members $700
3 DAYS A WEEK - Members: $1650; Non-Members $2000
- Tuition fees can be paid upfront, or over the course of the year up to 10 payments
- There is a $150 registration and special programs fee

CHILD #1 INFORMATION
CHILD #2 INFORMATION (if applicable)

PERSON NOT AUTHORIZED TO PICK UP CHILD

EMERGENCY CONTACT #1 - OTHER THAN PARENT/GUARDIAN
EMERGENCY CONTACT #2 - OTHER THAN PARENT/GUARDIAN

MEDICAL INFORMATION
CHILD #1 MEDICAL INFORMATION
CHILD #2 MEDICAL INFORMATION (if applicable)

Wed, December 11 2019 13 Kislev 5780