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Jkids Registration

Student Information
Full Name*

First Name Last Name
Hebrew Name*

First Name Last Name
School*
Previous Jewish Education
Birth Date*

Month Day Year
Father's Name*

First Name Last Name
Grade entering*
Additional notable Information Please let us know if there are any allergies or other important information we need to be aware of.
Father's Cell*

Area Code Phone Number
Parents Information

Address*

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

Mother's Cell*

Area Code Phone Number
Mother's Name*

First Name Last Name
Best way to send JKids updates:*

Cell PhoneEmailHandout
Mother Jewish by:*

BirthChoice
Mother's Hebrew Name
I am willing to assist in school activities, please contact me
Payment
Annual Fee

$200
Sibling Discount

180
Total

$0.00

Payment

Credit Card eCheck

Postal / Zip Code

Country

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