CKids Hebrew School Registration

Student Information
Number of Children Being Registered* *Please fill out a separate form for each child.
Child's Name*
First (& Middle) Name Last Name
Full Hebrew Name*
Gender*
Date of Birth*

Month Day Year
(Approximate) Time of Birth- AM/PM* To calculate Hebrew Birthday
School*
Previous Jewish Education
Grade entering*

Address*

Allergies or Medical Concerns
Additional Information Please let us know if there is anything additional that the school should be aware of. (Confidential)
Parent Information
Father's Name*
First Name Last Name
Father Jewish by:*

BirthChoiceOther
Father's Cell*

Area Code Phone Number
Father's E-mail*
Mother's Name*
First Name Last Name
Mother's Hebrew Name*
Mother Jewish by:*

BirthChoice
Mother's Cell*

Area Code Phone Number
Mother's E-mail*
Were there any conversions in the family?*

YesNo
Which family member?
Emergency Information
Emergency Contact*
First Name Last Name
Phone Number*

Area Code Phone Number
Relationship*
Payment options
Pay in full*

1500Pay in 3 installments of 500
Promo code (only when paying in full)
Promo activated
Promo activated
Scholarship Donation I'd like to give a student in need a chance to receive a Hebrew School education.

$180.00
Total

$0.00
A separate charge for the 3% processing fee will be added to all payments made by credit card.

Payment*

Credit Card

We accept Visa, MasterCard, American Express, Discover
Credit Card Number	Security Code
Name on Card
Expiration Month	Expiration Year

Billing Address

Street Address

City

State / Province

Postal / Zip Code

Country

*

CKids Hebrew School is hereby granted permission to use any photo or video showing our child/ren involved in school activities.If an emergency arises (G-d forbid) and none of the above numbers can be contacted, I hereby give CKids Hebrew School permission to take whatever measure it feels proper and necessary considering circumstances.
Please look out for an email confirming that your child has been successfully enrolled in Hebrew School.

We are looking forward to a wonderful year of Jewish learning and fun together!
I would like to receive news and updates by email
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