If you prefer to manually fill out this application and email it to Club Ed, please download the application here.
Primary Parent/Guardian Information
Secondary Parent/Guardian Information
Click your School District for Payment Information
Fort Lee Edgewater North Bergen Fairview Palisade Park
Please place 4 digits of your credit/debit card in each box.
For American Express Cards, please disregard the 4th box.
By choosing YES, you authorize JFCS to charge your credit card or checking account monthly.
By choosing NO, you will have monthly invoices emailed to you for online payment.
My child may be released to the following people in case of an emergency or following emergency medical care. The following authorized individuals may be called during program hours if I am not available.
Child Release of Child
Please list any additional authorized individuals who may pick up your child from Club Ed. You can add or remove inidividuals at any time by emailing email@example.com.
Do NOT release my child to the following people:
Children requiring an EpiPen must provide Club Ed with 2 EpiPens in their original box with the pharmacy label and an emergency action plan from their doctor prior to their first day. If the action plan states the use of Benadryl, you must also provide Club Ed with Benadryl and a dosing cup.
Policies and Procedures Acknowledgement
Click here to view the Club Ed Parents/Guardians Manual
By signing below, I agree I have received and understand the following information which is stated in the Club Ed Parents/Guardians Manual: