Jubilee Christian School
Extended Day Program Registration

Child's Name:
Age:
Birth Date:
 Grade in the Fall:
Parent or Guardian:
Address:
City: State:
Zip Code:
Home Phone: - - Work Phone: - -
Cell Phone: - - Email:
Emergency contact information for the Extended Day Program:
Name:
Address:
Home Phone: - - Cell Phone: - -
Additional phone number for this party:
Alternate contact for emergency:
Address:
Home Phone: - - Cell Phone: - -
Special information regarding custody arrangements, additional pick up people, or out of the ordinary circumstances regarding your child:
I have read the Extended Day Program Policies document and agree to those stipulations.
Parent or Guardian Signature:
     



Jubilee Christian School admits students of any race, color, national and ethnic origin to all the rights, privileges, programs, and activities generally accorded or made available to students at the school. It does not discriminate on the basis of race, color, national and ethnic origin in administration of its educational policies, admissions policies, scholarship and loan programs, and athletic and other school-administered programs


Jubilee Christian School ~ 255 Washington Road, Mt. Lebanon, PA 15216  
Phone: 412-561-5917  ~  Fax: 412-561-2857
E-Mail: judi.phelps@jubileechristianschool.org