Apply

First Name *

Last Name *

Email Address *

Phone Number

Child's First Name

Child's Last Name

Child's Birthdate0 / 100

Please add any additional information you wish about your and your child's needs.0 / 500

Email the SJICC Director at abbyh@jlsfrc.org. You may also send us a message using the form below.

Send us a message

First Name

Last Name

Email Address *

Phone Number

Message *0 / 200