JUDA Registration form 2018 - 2019 - Chabad of Baton Rouge

Child's Name*
First NameLast Name
Hebrew Name*
Birth Date*
MonthDayYear
School
Grade entering*
Child # 2 Name
First NameLast Name
Hebrew Name*
Birth Date*
MonthDayYear
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 - includes all books, crafts etc.
Please select the number of children registeringEarly Bird Special until June 15th
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.

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