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JUDA Registration Form
JUDA After School Club - Learn It! Live it! Love it!
A program where LEARNING, CREATIVITY and FUN come together, where children don't want to miss a week.
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* Indicates required question
Email
*
Your email
Name of Child:
*
Your answer
Child's Hebrew Name:
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Your answer
Date of Birth: (approximate time of birth to calculate hebrew birthday)
*
MM
/
DD
/
YYYY
Time
:
AM
PM
Name of School:
*
Your answer
School year starting in September 2022:
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Your answer
Mother's Hebrew Name:
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Your answer
Was mother born Jewish?
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Yes
No
Father's Hebrew Name:
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Your answer
Members of which Synagogue:
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Your answer
Married under the auspices of which Synagogue:
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Your answer
Child's previous Jewish education (if any):
*
Your answer
Address:
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Your answer
E-mail:
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Your answer
Home Phone Number:
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Your answer
Mother's mobile:
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Your answer
Father's mobile:
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Your answer
Alternative Emergency Contact - name, phone number and relationship to the child:
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Your answer
Allergies:
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Your answer
Any medical info:
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Your answer
PARENT'S CONSENT
*
I consent to photographs of my child being taken, and possibly being used for publicity purposes.
I do not consent to photographs of my child being taken, and possibly being used for publicity purposes.
Required
Parents/Guardian signature:
*
Your answer
Date:
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MM
/
DD
/
YYYY
Please note, £50 deposit required on acceptance to ensure your child's place, Rochel will be in touch with you.
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