JKC Enrollment Form

Jewish Kids Club Enrollment form

We are currently accepting application forms for the upcoming school year 2024-25. Please fill out ALL fields of this form.

If you have any questions or concerns you'd like to discuss with us, please contact Fraidy at [email protected]

We look forward to a wonderful year!

Each session is around 11 club meetings.
- Fee $275 per season + Optional Hebrew reading for $50 per season
  Sibling discount available
All information is kept for internal use only. We don't share your data with anyone outside our organization.
How Many Children signing up*
Student Profile - Child #1
Full Name*
First Name Last Name
Which session is your child signing up for* Each session is around 11 club meetings

Fall Session (Aug. 14th - Nov 13th) $275Winter Session (Nov. 20th - Feb 12th) $275Spring Session (Nov. 19th - May 21st) $275All 3 Sessions (Discounted) $725
Optional Hebrew reading 5:00 - 5:30 pm after each club meeting

Fall Session $50Winter Session $50Spring Session $50All 3 sessions $150
Hebrew Name* Write "Does not have" if he/she doesn't have one
Gender *
Birth Date*

Month Day Year
* To calculate Hebrew birthday

Before SunsetAfter SunsetNot Sure
Hebrew Reading Proficiency*

NoneSomewhatWell
Does your child have any learning difficulties with General Studies? If yes, please describe:
Are there any special Medical needs or other information that we should be aware of?
Does your child have any allergies? If yes, please specify:
Student Profile Child #2
Full Name*
First Name Last Name
Which session is your child signing up for* Each session is around 11 club meetings

Fall Session (Aug. 14th - Nov 13th) $250Winter Session (Nov. 20th - Feb 12th) $250Spring Session (Nov. 19th - May 21st) $250All 3 Sessions (Discounted) $675
Optional Hebrew reading 5:00 - 5:30 pm after each club meeting

Fall Session $50Winter Session $50Spring Session $50All 3 sessions $150
Hebrew Name*
Gender *
Birth Date* If not sure about time, put in the estimated time

Month Day Year
* To calculate Hebrew birthday

Before SunsetAfter SunsetNot Sure
Hebrew Reading Proficiency*

NoneSomewhatWell
Does your child have any learning difficulties with General Studies? If yes, please describe:
Are there any special Medical needs or other information that we should be aware of?
Does your child have any allergies? If yes, please specify:
Student Profile Child #3
Full Name*
First Name Last Name
Which session is your child signing up for* Each session is around 11 club meetings

Fall Session (Aug. 14th - Nov 13th) $250Winter Session (Nov. 20th - Feb 12th) $250Spring Session (Nov. 19th - May 21st) $250All 3 Sessions (Discounted) $675
Optional Hebrew reading 5:00 - 5:30 pm after each club meeting

Fall Session $50Winter Session $50Spring Session $50All 3 sessions $150
Hebrew Name*
Gender *
Birth Date*

Month Day Year
* To calculate Hebrew birthday

Before SunsetAfter SunsetNot Sure
Hebrew Reading Proficiency*

NoneSomewhatWell
Does your child have any learning difficulties with General Studies? If yes, please describe:
Are there any special Medical needs or other information that we should be aware of?
Does your child have any allergies? If yes, please specify:
Family Information

Address*

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

Father's Name*
First Name Last Name
Father's Hebrew Name*
Father's Birth Date*

Month Day Year
Cell Phone Number*
Father's E-mail*
Mother's Name*
First Name Last Name
Mother's Hebrew Name*
Mother's Birth Date*

Month Day Year
Cell Phone Number*
Mother's E-mail*
Marital Status*

MarriedSingleDivorced
Background
Was the natural mother and Father of the child(ren) Jewish?*

YesNo
If no, please explain
Was the maternal grandmother of the child born Jewish?*

YesNo
Are there any conversions or adoptions in the family?*

YesNo
If yes, please explain
Medical Information
Family Physician:*
Emergency Contact:*
Relation:*
Phone Number*
Medical Release:*

I hereby give consent to the administration of the Chabad Jewish Kids Club to take whatever medical measures they deem necessary, at my expense, for my child in the event of a medical emergency.
Permission Slips:*

I hereby give permission to my child to participate in all school outings and field trips outside usual club meetings and to use any transportation selected by the Jewish Kids ClubI grant permission for my child to be photographed in individual or group pictures which may be used by Chabad Oviedo-Winter Spring for P.R.
Payment Information:
This page uses a secure connection and your information will not be shared with anyone.

The Jewish Kids Club does not turn anyone away due to lack of funds. If you are in need of financial assistance please reach out to Rabbi Tzvi Dubov at [email protected]
Payment plan

I would like to set up a payment plan.
Someone from the office will reach out to set up a payment plan.

Please note your registration is not complete until the payment plan is set up.

Click SUBMIT below.
Total

$0.00

Payment

Credit Card

We accept Visa, MasterCard, American Express, Discover
Credit Card Number	Security Code
Name on Card
Expiration Month	Expiration Year

Billing Address

Street Address

City

State / Province

Postal / Zip Code

Country

I would like to receive news and updates by email
Should be Empty:

This page uses TLS encryption to keep your data secure.

Student Profile - Child #1

Student Profile Child #2

Student Profile Child #3

Family Information

Background

Medical Information

Payment Information: