Kidz Club Registration

Join our exciting After School Program!

Student Information

First Name *

Last Name *

Hebrew Name *

Date of Birth *

Grade Entering *

Previous Jewish Education

School *

Please specify school *

Will you need pickup? *

Yes No

Home Address *

Additional Notable Information

Allergies, Medical Conditions, etc.

Parents Information

Father's Name *

Cell Phone *

Email *

Mother's Name *

Hebrew Name

Cell Phone *

Email *

Is Mother Jewish? *

I am willing to assist in program activities, please contact me.

Registration & Payment

Registering For: *

$0.00

Choose Payment Method *

Credit Card

Other / Check

Someone will reach out to you to discuss payment options. Thank you!

Processing Registration...

✓

Registration Complete!

Thank you for signing up for the Kidz Club!

We're excited to have you join our family!