Registration

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To get started, select one:

First Time JUDA ParentReturning JUDA Parent
REGISTER

Please fill out ALL fields of this form. Confirmation of acceptance will be acknowledged after this registration form is reviewed and an acceptance email is received.

We look forward to a wonderful year of learning and growth.

If you have any questions, feel free to contact Tzippy Fuss, JUDA director, who will be happy to discuss any questions you may have.

Email: CLICK HERE
STUDENT INFORMATION
Child 1:
Full Name*
Birth Date*

Month Day Year
Grade Entering*
I have another child to sign up

YesNo
Child 2:
Full Name
Birth Date

Month Day Year
Grade Entering
Does your child read basic Hebrew?

YesNo
Previous Jewish education?

YesNo
Are the natural parents of the child Jewish?*

BothMotherFatherNone
Were there any conversions or adoptions in your family?*

YesNo
If Yes - please explain
FAMILY INFORMATION
Mother's Name*
First Name Last Name
Mother's Cell*

Area Code Phone Number
E-mail*
Father's Name*
First Name Last Name
Father's Cell*

Area Code Phone Number
E-mail*

Address*

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

EMERGENCY CONTACT & MEDICAL INFORMATION
Persons to be contacted in case of an emergency when parents cannot be reached: (Please provide at least two contacts)
Emergency Contact 1:*
Emergency Contact 2:*
Is there any special medical or other information regarding your child(ren), of which we should be made aware?
Does your child(ren) have behavioral support in his/her regular school?*

YesNoPart Time
Authorization

I hereby give permission for my child(ren) to be transported to and from field trips and to participate in them in all JUDA activities. I understand that during the course of JUDA my child(ren) can be hurt. I accept the risk of possible injury and authorize any member of the JUDA staff to render any necessary first aid. Furthermore, in an emergency case, I hereby authorize Chabad Jewish Community Center of Riverside personnel to have my child(ren) taken care of by a physician or other medical person in any way the situation calls for.
Transport/Emergency Care as listed above*

I give permission.I don't give permission
Initial Here:*
I give permission to JUDA, and those authorized by JUDA, to take photographs and to make recordings of my children and my family, and to use them in original or modified form in all media now or hereafter known, with or without my name or information about me, for the promotion, public education, and/or fundraising activities of JUDA or Chabad Jewish Community Center of Riverside
Media Authorization*

I give permissionI don't give permission
Initial Here:*
Payment

Full tuition: $550
Register by August 30th: $500
Includes registration fee, books and all supplies.

Discounts:
5% discount off for each additional child of the same family.
5% additional discount off your total tuition for each child of another family you successfully introduce to JUDA.
I am registering:

One Child - $500Two Children - $500 + $475 = $975Subsidized Rate One Child - $375Subsidized Rate Two Children - $375 + $356.25 = $731.25
I want to support a child needing tuition assistance, gifting them this special experience.

$100$180$375$500
Total to be charged today*

$
Charge my card monthly over:

4 months8 months

Payment*

Credit Card Paypal

Postal / Zip Code

Country

Please note: Your child is not registered in JUDA until you receive an acceptance confirmation phone call or email.
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Educate Your Child... Educate a Generation

STUDENT INFORMATION

FAMILY INFORMATION

EMERGENCY CONTACT & MEDICAL INFORMATION