JUDA Registration form 2019 - 2020

Child's Name*
First NameLast Name
Hebrew Name*
Birth Date*
MonthDayYear
What time was your child born?*In Judaism the day begins at nightfall, so before we can return the exact date of your Jewish birthday we need to determine what time of day you were born.
MorningAfternoon or evening before midnight
School
Grade entering*
Child # 2 Name
First NameLast Name
Hebrew Name*
Birth Date*
MonthDayYear
What time was your child born?*In Judaism the day begins at nightfall, so before we can return the exact date of your Jewish birthday we need to determine what time of day you were born.
MorningAfternoon or evening before midnight
School
Grade entering*
Is the natural mother of the child Jewish?
YesNo
Were there any conversions or adoptions in the family?
YesNo
Previous Jewish Education / Hebrew reading abilities*
Any medical or learning conditions we should be aware of?
Parents Information
Father's Name*
First NameLast Name
Father Cell
Area CodePhone Number
Mother's Name*
First NameLast Name
Mother Cell
Area CodePhone Number
Does the child live with both parents?
Tuition
Please select the number of children registeringEarly Bird Special until June 15th
Supplies Fee $25 per child*Please select the number of children registering
Total
$0.00
Concent
I hereby permit my child to participate in all activities of JUDA - on site, off site and trips.In case of any emergency I hereby authorize the staff of JUDA to take appropriate action, and absolve them, and any parent organization(s) of any liability.I hereby permit my child to be photographed and vidoed, and I allow JUDA to use those photographs at their discretion.
Please select your payment plan*If your preference is to not pay in full now, please select Other in payment type
Pay in full nowPlease run my card for the total amount at the start of next monthI'd like pay in four installments

Payment

Credit Card Other

Postal / Zip Code

Country

Completing this form does not guarantee a spot in JUDA. All applications are subject to review.
No one will be turned away due to lack of funds!
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Parents Information

Tuition