Jewish Kids Club Registration Child ProfileName* First Last Hebrew Name* School* Grade* Date of Birth* MM slash DD slash YYYY Age*To determine your child's Jewish birthday, what time of day (approx.) was your child born?* Hours : Minutes AM PM I am enrolling my child for:* Mondays Wednesday I am enrolling my child for:* Select All Fall Winter Spring 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 Would you be interested in school pick-up?* YES NO Persons authorized to pick-up my child Emergency InformationEmergency Contact 1* First Last Phone*Emergency Contact 2* First Last Phone*Physician* First Last Phone*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. Dates & RatesTuition 2021-22 Financial Aid/Tuition Assistance – Contact Leah@JewishPreschool.org 2 days/week: $24/day 1 day/week: $25/day Drop - In: $35/day Current CCJP Student (enrolled in Late Care) = $10/day (5:00 PM – 6:00 PM) 10% discount for former CCJP students and current students ages 5+ not enrolled in late care $100 discount for families who enroll for all 3 semesters and submit payment in full by Sept. 6th.