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JUDA Registration

Child's Info
Child's Name*
First Name Last Name
Child's Hebrew Name
Birth Date*

Month Day Year

Address*

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Grade Entering
School Attending
Additional Child
Child's Name
First Name Last Name
Child's Hebrew Name
Birth Date

Month Day Year
Grade Entering
School Attending
Does your child/ren have any allergies or other medical condition we should be aware of? If yes, please describe them and indicate special precautions or care needed.
Is your child/ren familiar with the Aleph Bet?
What would you like for your child/ren to gain and experience at Juda?
Is your child/ren familiar with the Jewish holidays?
Is your child's biological mother Jewish?
Are there any conversions in the family?

YesNo
If yes, please explain
Are you alright with photos of your child being used for promoting JUDA?

YesNo
Parent's Info
Parent 1
First Name Last Name
Hebrew Name
Cell Phone

Area Code Phone Number
E-mail
(Optional) Parent 2 Name
First Name Last Name
Hebrew Name
Cell Phone

Area Code Phone Number
E-mail
Emergency Contact

Contact Info

Name
Relationship
Cell Number	Home Number
Postal / Zip Code	Country

I hereby permit my child to participate in all JUDA activities. In case of an emergency, I hereby authorize the school to have my child taken care of by a physician in any way that the situation may call for.
Parent/Guardian Signature
Date

Month Day Year
Payment
Tuition: $700

Sibling discount: $100 off second child

Includes: 31 sessions of JUDA, special hands-on holiday workshops and activities.
One time payment

$700
Please charge my card monthly

$70
Two children (sibling discount: $100 off)

$1300

Payment

Credit Card Check

Postal / Zip Code

Country

At JUDA, every child is welcome!

Payment plans and scholarships are available; no child will be turned away due to lack of funds.

Contact us for more details - [email protected] , or 831-295-7711.
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