Program Registration Form

Choose your Campus:

Student(s) Information

First Child

First NameLast Name

Second Child

First NameLast Name

First Child's Birthday

Date

Second Child's Birthday

Date

Current School

Grade in Sept 2026 (First child)

Grade in Sept 2026 (Second child)

Allergies

input n/a for none

Special Medical, Physical or Emotional Needs that our teachers should be made aware of.

Parent Information

Parent Name

PrefixFirst NameLast Name

Cell Number

Format: (000) 000-0000.

Work Number

Format: (000) 000-0000.

E-mail

example@example.com

Home Address

Street Address

Street Address Line 2

City

Postal / Zip Code

Consent

Emergency Contact Information (Other than parent) - if applicable

Emergency Contact Name

First NameLast Name

Phone Number

Format: (000) 000-0000.

Relationship

Authorized for pick-up

Program(s) of interest - please choose the specific program for which you wish to receive information.

JEI Subject Programs (Weekly Class)

After School Club (JK-Grade 6)

Smart Saturday Pass 10am-12pm (JK-Grade 3) *Choose two subjects

PA Day Camp 9am-3pm, Pizza included | Extended hours 3-5pm $15/day

March Break Camp Starry Skies & Ocean Eyes (JK-Grade 4) ONLY AT ELGIN MILLS

Summer Learning Club Drop-in Program July-August

Choose your subject(s) and your Pass option

Cathedraltown Summer Camp (Ages 4-8 only)

Summer Camp (JK-Grade 4) 9am-3pm at Elgin Mills / North Richmond Hill Campuses

Comments

Terms & Conditions

Please click yes if you WILL give permission to have photographs taken of your child

We occasionally take pictures of the kids in action with the materials or doing other activities for our website, and various Social Media platforms. We hope to use these to keep parents up to date on the happenings at the center.

How did you find us?

If you were referred by a friend please let us know who, so we can thank them!

JEI Learning Center would like your consent to send informational text message communications from +18335348898 to your mobile number listed above, in response to your questions or to provide information relevant to your relationship with us.Consent is not a condition of purchase. Message frequency varies. Message and data rates may apply. Reply 'STOP' to unsubscribe at any time. Reply 'HELP' for assistance or more information. We do not share your mobile opt-in information with anyone. See our privacy policy and messaging terms and conditions available by request for more information.

Parent Signature

Enter the message as it's shown

IMPORTANT: This form simply accepts your registration information. It is not a confirmation of guaranteed enrollment, as spaces in our class and camp programs are limited. We will contact you within two business days to communicate if your desired session is available. If it is, we will formally confirm your registration and send you the program information packet and payment link. Thank you for your attention.