Jewish Kids Club Registration Child ProfileName* First Last Hebrew Name* Date of Birth* MM slash DD slash YYYY School* Grade* Age*To determine your child's Jewish birthday, what time of day (approx.) was your child born?* Hours : Minutes AM PM Family InformationMother's Name* First Last Mother's Email* Phone*Father's Name* First Last Father's Email* Phone*Address* Street Address City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Is your child's Father Jewish?* Yes No Is your child's Mother Jewish?* Yes No Are there any conversions in the family?* Yes No Please explain:*Are there any adoptions in the family?* Yes No Please explain:*Emergency InformationEmergency Contact 1* First Last Phone*Emergency Contact 2* First Last Phone*Physician* First Last Physician's Phone Number*CONFIDENTIAL:*Does your child have any allergies or other medical condition we should be aware of? If yes, please describe them and indicate special precautions or care needed. Persons authorized to pick-up my child from Hebrew School Does your child attend any special education program?* Yes No Please explain:*Does your child have any special abilities or disabilities?* Yes No Please explain:*Is your child on any special medication that the school should be aware of?* Yes No Please explain:*If you are new to our program, please tell us about your child's previous education.*Program Selection*Pay in full by July 31st, 2024 to receive a $100 discount on tuition Wednesdays | 3:30 PM - 5:30 PM $1,250 Would you be interested in school pick-up on Wednesdays?* YES NO Which elementary school does your child attend? We look forward to a wonderful year of learning and growth at Center City Chabad Hebrew School! TuitionTuition can be paid by cash, check, money order, or bank transfer. Please make your check payable to: Center City Jewish Preschool 527 Lombard Street Philadelphia, PA 19147EmailThis field is for validation purposes and should be left unchanged.
