Online Registration Form for 2017 - 2018 School Year

Number of Children included in this registration *

Parent Contact Information

First Parent's First Name: *

Family Name *

Email *

Home Phone *

Cell Phone *

Work Phone *

Second Parent Contact Information

Second Parent's First Name

Second Parent's Family Name

Second Parent's Email

Second Parent's Home Phone

Second Parent's Cell Phone

Second Parent's Work Phone

First Child Information

Child's First Name *

Child's Family Name *

Birth Date *

Health Card #: *

School: *

2017/18 School Grade *

Second Child Information

Child's First Name

Child's Family Name

Birth Date

Health Card #:

School:

2017/18 School Grade

Third Child Information

Child's First Name

Child's Family Name

Birth Date

Health Card #:

School:

2017/18 School Grade

Fourth Child Information

Child's First Name

Child's Family Name

Birth Date

Health Card #:

School:

2017/18 School Grade

Emergency Contacts

(please list 2 contacts, other than parents, to be called in an Emergency)

First Name: *

Family Name *

Cell Phone *

Second Contact: First Name *

SecondContact: Family Name *

Second Contact Cell Phone *

Required Accommodations:

The DJC is committed to ensuring that all students in our program have equal access to a Jewish education, regardless of their physical and/or intellectual needs. Please let us know if your child requires accommodations so we can make their education an inclusive and exciting experience.

Please list any specific concerns (learning requirements, allergies, food restrictions, etc, your child may have):

VOLUNTEERING

Volunteers are the very lifeblood of our Children's Jewish Studies Program. We simply could not exist were it not for the dedication and devotion of a handful of members. We need your help. A few hours of your time could make a world of difference to us... and you and your child.

I would like to:

Join the Education Committee

Be a Class Parent

I would like to help plan:

Chanukah

Purim

Passover

Other

I would like to help with:

Building the Community Sukkah

Set/Clear for Potluck Services

Set/Clear for Shabbat Services

YEARLY FEES

Registration fees are:

$800 per child for DJC member families
$1050 per child for non-member families
Yearly fees include a $75 non-refundable registration fee

REFUND POLICY

for a registered student who is withdrawn prior to or during the school year

Before August 14: Full refund minus $75 registration fee
August 15 to completion of second class: Full refund minus $200 registration fee
Beginning of third class, no refund

PAYMENT

Are you a DJC member? *

Yes

Donation to the Children's Jewish Studies Program

The DJC Children’s Jewish Studies Program relies on the support of the community and member donations. The actual cost for the program is over $1,050 per student. Please donate to support our child and youth programs if you can.

Total:

Online Registration Form for 2017 – 2018 School Year

Parent Contact Information

Second Parent Contact Information

First Child Information

Second Child Information

Third Child Information

Fourth Child Information

Emergency Contacts

Required Accommodations:

VOLUNTEERING

YEARLY FEES

REFUND POLICY

PAYMENT