JUDA Registration form 2019 - 2020 - Chabad of Baton Rouge

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?

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?

Please select the number of children registeringEarly Bird Special until July 5th

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!

JUDA Registration form 2019 - 2020

Parents Information

Tuition