JUDA

Child's Name*

First NameLast Name

Child's Hebrew Name

Hebrew Name

Child's Birth Date

Date of Birth

Email to be used for all communication*

example@example.com

Home address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Child's grade for the new school year*

Does your child have any allergies we should be aware of?

Yes

Child 2 name

First NameLast Name

CHild 2 Hebrew Name

Hebrew Name

Child 2 Birth Date

Date of Birth

CHILD 2 GRADE FOR THE NEW SCHOOL YEAR

Grade

YesSomewhatNo

Was born JewishConverted to JudaismIs not Jewish

Are there any adoptions in your family (children, parents or grandparents)?*

Father's name*

First NameLast Name

Father's number*

Format: (000) 000-0000.

Father's occupation

Mother's name*

First NameLast Name

Mother's number*

Format: (000) 000-0000.

Mother's occupation

Mother's hebrew name

COST: $300/session or $550/year (if registering for both sessions today)

EARLY BIRD: A 10% early-bird discount is available for registrations until July 24th - Promo code "earlybird"!

SIBLING: an ADDITIONAL 5% discount is available - reflected in the payment section.

No child will be turned down based on tuition costs. Please email us at Office@JewishShelton.com so that we can ensure your child can attend JUDA.

Pay full amount todayPay in installments

How much would you like to be charged today and for upcoming payments?

Payment Schedule?

How many installments?

We will be in touch with you shortly about collecting your payment info, and setting up the recurring payments with all of the applicable discounts based on your answers above!

Payment - Sibling discount is automatically calculated

Session #1

$300.00 How many children?

Session #2

$300.00 How many children?

Full year

$550.00 How many children?

Enter coupon

Total

$0.00

Credit Card

First Name

Last Name

Credit Card Number

Security Code

Expiration Month

Expiration Year

Billing Address

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Country

JUDA Registration

General Info

Religious & Educational History

Contact Info