Jewish Kids Club

Address*

2. Parent's Information
Mother's Name*
First Name Last Name
Hebrew Name
Cell No.
E-mail
Father's Name*
First Name Last Name
Hebrew Name
Cell No.
E-mail
3. Emergency Contact
Emergency Contact *
First Name Last Name
Phone No.*
Relationship*
Pediatrition
First Name Last Name
Phone No.
Important Medical information, allergy or dietary restrictions or other notes.*
How would you describe your child's Hebrew reading skill?
What are you hoping your child gains at Jewish Kids Club this year?
4. Payment Method
Full Program $399

Selected Lessons $45
No child will be turned away due to lack of funds. For scholarships, please contact Chana Braun at [email protected]
When will your child be attending?

Full ProgramSelected Weeks
Selected Weeks*

Oct 11 - 30 TishreiOct 25 - 14 CheshvanNov 8 - 28 CheshvanNov 22 - 12 KislevDec 13 - 3 TevetDec 27 - 17 TevetJan 10 - 2 ShvatJan 24 - 16 ShvatFeb 7 - 30 ShvatFeb 28 - 21 Adar IMar 14 - 5 Adar IIApr 4 - 26 Adar II

Payment

Credit Card Check

Postal / Zip Code

Country

Total

$0.00
Agreements*

I am signing up my children for Jewish Kids Club, I give my children permission to receive medical care in the case of an emergency, G-d forbid. I agree that Jewish Kids Club, its administration and staff, will not be liable for any injury or health impairment that may occur.
*

I give Jewish Kids Club permission to photograph and videotape my children and use the photos and videos (without using their names) as it sees fit.
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