JUDA

Child's Name *

First Name Last 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

City State / Province

Postal / Zip Code

Child's grade for the new school year *

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

Would you like to register a 2nd child?

Yes

Child 2 name

First Name Last Name

CHild 2 Hebrew Name

Hebrew Name

Child 2 Birth Date

Date of Birth

CHILD 2 GRADE FOR THE NEW SCHOOL YEAR

Grade

Does your child read basic hebrew?

Yes Somewhat No

Father of the child

Was born Jewish Converted to Judaism Is not Jewish

Mother of the child

Was born Jewish Converted to Judaism Is not Jewish

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

Father's name *

First Name Last Name

Father's number *

Father's occupation

Mother's name *

First Name Last Name

Mother's number *

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.

Payment *

Pay full amount today Pay 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