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?

Yes
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?

YesSomewhatNo
Father of the child

Was born JewishConverted to JudaismIs not Jewish
Mother of the child

Was born JewishConverted to JudaismIs not Jewish
Are there any adoptions in your family (children, parents or grandparents)?*
Contact Info
Father's name*

First NameLast Name
Father's number*
Father's occupation
Mother's name*

First NameLast Name
Mother's number*
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*

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 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

$0.00

Credit Card Details
First Name	Last Name
Credit Card Number	Security Code
Card Expiration

Should be Empty:

JUDA Registration 2024-5

General Info

Religious & Educational History

Contact Info