Registration

Student Information
Full Name*
First Name Last Name
Was this student enrolled in JUDA for the 24-25 session?*

YesNo
Birth Date*

Month Day Year
Grade Entering*
Check as many or as few apply.

My child can read basic Hebrew.My child has had some previous Jewish education.
Please describe any allergies to food or medicines:
Please describe any special medical or behavioral information that we should be made aware of:
Additional Student
Do you have another child to enroll?*

YesNo
Full Name*
First Name Last Name
Was this student enrolled in JUDA for the 24-25 session?*

YesNo
Birth Date*

Month Day Year
Grade Entering*
Check as many or as few apply.

My child can read basic Hebrew.My child has had some previous Jewish education.
Please describe any allergies to food or medicines:
Please describe any special medical or behavioral information that we should be made aware of:
Parent's Information
Mother
Name*
First Name Last Name
E-mail
Cell Phone*
*

Born JewishConverted to JudaismNot Jewish
Check here if there were any adoptions or conversions in the mother's family.
Details
Father
Full Name*
First Name Last Name
E-mail
Cell Phone*
*

Born JewishConverted to JudaismNot Jewish
Check here if there were any adoptions or conversions in the father's family.
Details
Household

Address*

Family E-mail* Best Email for Correspondence
Emergency Contact
First Contact
Full Name
First Name Last Name
Phone Number
Relation to Student
Second Contact
Full Name
First Name Last Name
Phone Number
Relation to Student
Authorizations
I give permission for my child(ren) to participate in all JUDA activities. I understand there is some risk of injury and accept this risk. I authorize JUDA staff to give first aid, and in an emergency, to arrange medical care for my child(ren) as needed.
Select One:*

AgreeDecline
I permit JUDA/Chabad JCC of Riverside to photograph or record my child(ren)/family and use the images for promotional, educational, or fundraising purposes.
Select One:*

AgreeDecline
Tuition
Sliding Scale Pricing: We want every Jewish child to be able to participate. Choose what feels right for you.
- Full tuition: $750
- Subsidized Tuition: $550
- Flexible Pay Schedule
- Register by September 12: Full Tuition $690 / Subsidized $500
(Tuition includes registration fee, books, and all supplies)

Sibling Discount: 5% off each additional child from the same family.
Choose One:*

Full Tuition $690.00Subsidized Tuition $500.00
Choose One:* Sibling Discount Applied

Full Tuition $1,345.50Subsidized Tuition $975
Donation
I want to support a child needing tuition assistance, gifting them this special experience.
$100$180$375$500
Payment
Payment Schedule*

Pay the entire balance today.4 Payments (every other month) starting today8 monthly payments starting today

Payment Method*

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