JUDA Application Form 2025-2026 - Chabad of Cypress and Northwest Houston

Child's Information:

Number of Children Registering:*

Child 1 Full Name*

First Name Last Name

Hebrew Name

Date of Birth*

Month Day Year

Child Born *

Before SunsetAfter Sunset

School and Grade Attending*

Child 2 Full Name

First Name Last Name

Hebrew Name

Date of Birth

Month Day Year

Child Born

Before SunsetAfter Sunset

School and Grade Attending

Parents' Information:

Address where child/ren reside/s:*

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Mother's Name*

First Name Last Name

E-mail*

Phone Number*

Area Code Phone Number

Mother Jewish?*

YesNo

Father's Name*

First Name Last Name

E-mail*

Phone Number*

Area Code Phone Number

Father Jewish?*

YesNo

Have there been any conversions or adoptions in the family?*

YesNo

If yes, please explain

Maternal Grandmother Jewish?*

YesNo

Emergency Contact Information:

Full Name*

First Name Last Name

Phone Number*

Area Code Phone Number

Relationship to Child*

Address*

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Additional Information:

Is there any information about your child you think we need to know:

Tuition:

Early bird discount for JUDA until August 12 is $675 per child. (this includes registration & book fee)
Tuition price (after August 12) for JUDA is $750 per child. (this includes registration & book fee)

There is a 10% sibling discount for same families. Please select 2 children option for payment.
Additional 10% discount for bringing a friend and referring another family that joins.

Price includes all supply kits, snacks and sessions from September 7, 2024 through May 2025 with holiday and vacation breaks.

Payment plans available.
No child will be turned away for lack of funds

Please Select one of the following payment plans:*

PLAN A: I would like to pay in full for the entire year.I would like to pay in full-2 Children.PLAN B: I would like to pay in monthly installments.I would like to pay in monthly installments-2 Children.PLAN C: I would like to pay by check or other means/ I would like to request a scholarship.

Parental Consent and Agreement:

* I will notify the facility immediately of any changes to the information provided on this form.

* I agree to honor the payment plan selected above.

* I allow for photos of my children while participating in JUDA to be shared on social media, and in all other promotional materials, for newsletter and PR purposes.

* I give permission for my child to participate in all activities of JUDA.

* I give my consent for emergency medical treatment to be administered to my child in case of an injury.

* I AFFIRM THAT ALL THE INFORMATION PROVIDED IN THIS FORM IS TRUE.

Parent's Signature*

Date*

Month Day Year

Please note: Acceptance to JUDA is only confirmed once you receive an email confirming your child is accepted.

I would like to make an additional contribution to the Juda Scholarship Fund! Any amount is greatly appreciated!

$

Total

$0.00

Payment

Credit Card Other

Postal / Zip Code

Country

Child's Information:

Parents' Information:

Emergency Contact Information:

Additional Information:

Parental Consent and Agreement: * I will notify the facility immediately of any changes to the information provided on this form. * I agree to honor the payment plan selected above.

Parental Consent and Agreement:

* I will notify the facility immediately of any changes to the information provided on this form.

* I agree to honor the payment plan selected above.