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Chai Center for Jewish Life: 2023-2024 Learning Center Registration Form
Please fill out this form to register your child for the K-12 Learning Program.
***Please submit a separate form for each child.***
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* Indicates required question
Email
*
Your email
Student Last Name
*
Your answer
Student First Name
*
Your answer
Gender
*
Female
Male
Birthdate
*
MM
/
DD
/
YYYY
Hebrew Name
Your answer
Street Address
*
Your answer
City
*
Your answer
State
*
Your answer
Zip Code
*
Your answer
Home Phone
xxx-xxx-xxxx
Your answer
Parent/Guardian Email
*
Your answer
Additional Parent/Guardian Email
Your answer
School Attending for 2023-2024 School Year
*
Your answer
Grade attending September 2023
*
Kindergarten
1
2
3
4
5
6
7
8
9
10
11
12
Parent/Guardian #1 Last Name
*
Your answer
Parent/Guardian #1 First Name
*
Your answer
Parent/Guardian #1 Cell Phone
*
xxx-xxx-xxxx
Your answer
Parent/Guardian #1 Occupation
*
Your answer
Parent/Guardian #1 Religious background
*
Your answer
Parent/Guardian #2 Last Name
Your answer
Parent/Guardian #2 First Name
Your answer
Parent/Guardian #2 Cell Phone
xxx-xxx-xxxx
Your answer
Occupation
Your answer
Religious background
Your answer
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