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JKC Registration

JKC Registration

JKC Logo.jpg
2016-2017 (5777)

Please fill out a separate form for each child.

Child's Information
Child's Name

First / Last
Hebrew Name

Age

Grade

Does your child have any special learning or behavioral needs?

Mother's Information
Mother's Name

Mother's Hebrew Name

Address

Phone

E-mail

Please send all JKC Correspondence

Father's Information
Father's Name

Father's Hebrew Name

Address

Phone

E-mail

Please send all JKC Correspondence

Emergency

In the rare case that there is an emergency and we cannot reach either parents please let us know who we can call.
Name

Phone

I authorize all medical transportation, medical and surgical treatment, X-ray, laboratory, anesthesia, and other medical and/or hospital procedures which may be performed or prescribed by the attending physician and/or paramedics for my child and waive my right to informed consent of treatment. This waiver applies only in the event that neither parent/guardian can be reached in the case of an emergency.

I allow my child to be photographed and for the photos to be used in print, video and digital media.

I would like to sign up my child for the exciting year of Jewish Kids Club!

Please call me so we can discuss the JKC program.

Schedule:
Click here to see the JKC schedule. Within 5 days of signing up your child, you will receive a welcome package including a detailed schedule.

Payment:
JKC membership for the entire year (includes 18 lessons) is just $200! 

Sign up for "3-Part Families & Kids Pre-Passover Experience" for $30. Click here for information and details

 I plan to attend March 19 only

I plan to attend March 26 only

 I plan to attend April 2nd only

I will pay by Credit card

Credit Card Number


Expire

CVV

I prefer to send a check, made payable to Chabad of Novato to 7430 Redwood Blvd. Suite D Novato, CA 94945

For questions or payment plans, please call the office at 415-878-6770.

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