JUDA Club Registration
Your Information:
Parent/guardian
Name
*
Phone
*
E-mail
*
Relationship to child
*
Mother
Father
Other
Add additional parent/guardian
Name
Phone
E-mail
Relationship to child
Mother
Father
Other
Childs Information:
Child's Name
*
Child’s Jewish Name (if has/known)
Gender
*
Date of Birth
*
-
Day
-
Month
Year
Date
Time of birth, if known (to calculate Jewish birthday)
School
*
Year Starting in 2025
*
Home Address
*
Street Address
Street Address Line 2
City
County
Post Code
Additional Information:
Any Allergies or Medical conditions?
Does your child receive any extra support in school?
Child's previous Jewish education (if any)
Please tick all that are appropriate:
*
Child was born to a Jewish mother
There are conversions to Judaism in the child's maternal family
Child is not Jewish but interested in Judaism
Child is adopted into a Jewish family
Anything else you would like us to know?
Register a Second Child
Second Child:
Child's Name
Child’s Jewish Name (if has/known)
Gender
Date of Birth
-
Day
-
Month
Year
Date
Time of birth, if known (to calculate Jewish birthday)
School
Year Starting in 2025
Additional Information:
Any Allergies or Medical conditions?
Does your child receive any extra support in school?
Child's previous Jewish education (if any)
Please tick all that are appropriate:
Child was born to a Jewish mother
There are conversions to Judaism in the child's maternal family
Child is not Jewish but interested in Judaism
Child is adopted into a Jewish family
Anything else you would like us to know?
Register a Third Child
Third Child:
Child's Name
Child’s Jewish Name (if has/known)
Gender
Date of Birth
-
Day
-
Month
Year
Date
Time of birth, if known (to calculate Jewish birthday)
School
Year Starting in 2025
Additional Information:
Any Allergies or Medical conditions?
Does your child receive any extra support in school?
Child's previous Jewish education (if any)
Please tick all that are appropriate:
Child was born to a Jewish mother
There are conversions to Judaism in the child's maternal family
Child is not Jewish but interested in Judaism
Child is adopted into a Jewish family
Anything else you would like us to know?
Additional Emergency Contact
Besides for parents
Name
*
Phone
*
Relationship to child
*
Grandparent, Family friend, Aunt etc.
*
I give my consent for JUDA Staff to: 1- Administer first aid and if necessary take my child to the hospital in the event of an accident or emergency. (Please indicate above in the message box if your child is allergic to plasters). 2- Take and display photographs or videos of my child for updating parents and/or promotional purposes.
Additional Information
Members of which Synagogue (if any)
Married under the auspices of which Synagogue (if any)
How did you hear about JUDA Club?
Please keep me updated about all Bushey Chabad events
SUBMIT
Should be Empty: