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Judea Kids Club

Inspiring Jewish Pride and Identity in Jewish Children - the future of Judaism.

ב"ה

Register

Student Registration 2022/2023
Please fill out a seperate form for each child.

If you have any questions, you can call 954-613-2851 or email [email protected]
Full Name*

First Name Last Name
Hebrew Name*
Birth Date*

Month Day Year
School*
Previous Jewish Education
Grade entering*

Address*

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

Allergies*

Yes No
If yes, please specify:
List name(s) of those (other than parents) authorized to pick up this child:*
Parents Information
Father's Name*

First Name Last Name
Father's Hebrew Name
Father's Cell*

Area Code Phone Number
Father's E-mail*
Mother's Name*

First Name Last Name
Mother's Hebrew Name
Mother's Cell*

Area Code Phone Number
Mother's E-mail*
Is the mother Jewish?*

Yes No
Are there any conversion in the family?*

Yes No
If yes, please explain:
Payment and Tuition
Yearly tuition for K-7: $600

Early bird discount: $500 if registered by August 22, 2022

Each additional child in the family: $150

Due today: $50 deposit (which will be applied to tuition)

(If you need a payment plan or you feel that you need a scholarship, please call us. We will not turn anyone away for lack of funds.)
Payment options:* To be charged to credit card on file

Payment in full on September 1 3 equal payment on September 1, December 1 and March 1 I have spoken to the office regarding alternative payment plan
Registration Deposit

$50

Payment

Credit Card

Credit Card Type
Credit Card Number	Security Code
Name on Card
Expiration Month	Expiration Year

Billing Address

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Country

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Educate Your Child... Educate a Generation