JUDA Application Form 2024-2025

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 until August 15 will be $645 per child.
Cost (after August 15) for participation in JUDA is $695 per child.
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 15, 2024 through May 2025 with holiday and vacation breaks.
No child will be denied due to lack of funds.

For other payment options and scholarship assistance select plan C/other payment and contact [email protected].

Please select your option and submit payment info.

All payment plans will be charged in 5 monthly installments.
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

Should be Empty:

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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.