JUDA Registration 2024-25

JUDA Registration 2024-5

Chabad of Shelton
General Info
Child's Name

First NameLast Name
Child's Hebrew Name
Hebrew Name
Child's Birth Date

MonthDayYear
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?
Would you like to register a 2nd child?
Child 2 name

First NameLast Name
Child 2 Hebrew Name
Hebrew Name
Child 2 Birth Date

MonthDayYear
Date of Birth
Child 2 Grade for the new school year
Grade
Religious & Educational History
Does your child read basic Hebrew?
Father of the child
Mother of the child
Are there any adoptions in your family (children, parents or grandparents)?
Contact Info
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: $325/session or $600/year (if registering for both sessions today)

EARLY BIRD: A 10% early-bird discount is available for registrations until August 4th 2024 - Promo code "earlybird"!

SIBLING: an ADDITIONAL 5% discount is available - will be automatically 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
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 WILL BE AUTOMATICALLY APPLIED. NO PROMO CODE NECESSARY.

Session #1

$325.00 How many children?

Session #2

$325.00 How many children?

Full year

$600.00 How many children?

Enter coupon

Total

Debit or Credit Card
First Name	Last Name
Credit Card Number	Security Code
Expiration Month	Expiration Year

Should be Empty:

JUDA Registration 2024-5

General Info

Religious & Educational History

Contact Info

PAYMENT: SIBLING DISCOUNT WILL BE AUTOMATICALLY APPLIED. NO PROMO CODE NECESSARY.