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2026-2027 JAMS Afterschool
Registration Form
Please note, there is a non-refundable $30 application fee.
Parent 1
First Name
*
Last Name
*
Cell Phone
*
Home Phone
Work Phone
Email
*
Occupation
*
Street Address
*
Address Line 2
City
*
Postal Code
*
State/Province
*
Is parent 1 Jewish?
*
Yes
No
Are there any conversions in parent 1 family Background?
*
Yes
No
please explain more:
*
Is parent 1 a single parent?
*
Yes
No
Will other parent ever be responsible for drop-off or pickup?
*
Yes
No
Parent 2
First Name
*
Last Name
*
Cell Phone
*
Home Phone
Work Phone
Email
*
Occupation
*
Share address of
Same address as Parent 1
Street Address
*
Address Line 2
City
*
Postal Code
*
State/Province
*
Is parent 2 Jewish?
*
Yes
No
Are there any conversions in parent 2 family Background?
*
Yes
No
please explain more:
*
Child 1
First Name
*
Last Name
*
Gender
*
- Select -
Female
Male
Birth Date
*
Month
Month
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Day
Day
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Year
Year
2011
2012
2013
2014
2015
2016
2017
2018
2019
2020
2021
2022
2023
2024
2025
2026
Name of Current School
*
grade child is entering
*
- Select -
TK
K
1
2
3
4
5
6
favorite activities and interests
*
any allergies or medical conditions?
*
Yes
No
please specify
*
WHAT ARE YOU HOPING YOUR FAMILY WILL GAIN FROM the JAMS Jewish Afterschool EXPERIENCE?
Add another child
Enroll another child
Child 2
First Name
*
Last Name
*
Gender
*
- Select -
Female
Male
Birth Date
*
Month
Month
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Day
Day
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Year
Year
2011
2012
2013
2014
2015
2016
2017
2018
2019
2020
2021
2022
2023
2024
2025
2026
Name of Current School
*
grade child is entering
*
- Select -
TK
K
1
2
3
4
5
6
favorite activities and interests
*
any allergies or medical conditions?
*
Yes
No
please specify
*
Add another child
Enroll another child
Child 3
First Name
*
Last Name
*
Gender
*
- Select -
Female
Male
Birth Date
*
Month
Month
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Day
Day
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Year
Year
2011
2012
2013
2014
2015
2016
2017
2018
2019
2020
2021
2022
2023
2024
2025
2026
Name of Current School
*
grade child is entering
*
- Select -
TK
K
1
2
3
4
5
6
favorite activities and interests
*
any allergies or medical conditions?
*
Yes
No
please specify
*
JAMS Drop Off
Please note:
JAMS Afterschool is from 2:00 PM – 5:00 PM
Drop off at JAMS After School
*
- Select -
I will drop my child off at the JAMS Location: 283 Butterfield Rd.
Drop off at JAMS is difficult for me, I'd like to discuss other options.
I have arranged a carpool
Please let us know who your child will be carpooling with:
*
Emergency Information
Activity Subject
Name of Emergency Contact (not a parent)
*
Relationship to child
*
Phone number of Emergency Contact
*
List people authorized for pick up
*
Name of Physician in case of emergency
*
Phone number of Physician
*
Name of Dentist in case of emergency
*
Phone number of Dentist
*
Acknowledgments
*
jewish Status: I understand that JAMS is open to children from all backgrounds. Acceptance is not a validation of Jewish status.
Acknowledgments
*
Emergency Medical Treatment: I authorize any adult acting on behalf of JAMS to hospitalize or secure treatment for my child. I further agree to pay for all charges for that care and/or treatment. It is understood that, if time and circumstances reasonably permit, JAMS will try to communicate with me prior to such treatment.
Acknowledgments
*
Photo/ Audio/ Video/ Website Release: I consent to JAMS using photographs, audio recordings, and/or video footage of my child on its website and social media pages. No child’s name or personal information will be published alongside photos of minors attending JAMS.
Registration Fee
$
Payment Processor
*
Credit Card
PayPal
Chabad of West Marin
moshe@jewishwestmarin.org
|
415-910-8186
|
283 Butterfield Rd, San Anselmo, CA 94960
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