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All Day at the J - Program Interest Form
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Date
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Your answer
Child's Last Name
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Your answer
Child's First Name
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Your answer
Child's School District
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Your answer
Name of Child's School
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Your answer
Child's Grade as of September 2020
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Your answer
Parent Last Name
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Your answer
Parent First Name
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Your answer
Parent Email
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Your answer
Parent cell phone
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Your answer
Has your school/district announced opening plans for the fall? If yes, please provide details. If you know the daily schedule (particularly when synchronous learning will take place) please include.
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Your answer
Does your child have an IEP, 504 or other special learning plan? If yes, please provide details
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Your answer
Does your child have any medical concerns? If yes, please provide details.
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Your answer
Does your child have any socialization concerns? If yes, please provide details.
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Your answer
Please let us know your child's experience with remote learning this spring. Please provide details, both positive and negative.
Your answer
Pricing & Hours
Pricing: 5 full days, $1,900/month; 3 full days, $1,320/month; 5 half days, $1,100/month. 3 half days, $775/month
Hours: Full day: 8:30 am - 3:30 pm. AM Half day: 8:30am - 12:00 pm; PM Half day: 12:30 - 3:30 pm
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