Sign In Forgot Password

Teens Jewish Development Experience Reservation Form

Before filling out and signing this form, please click here to read and sign the Teens Jewish Development Experience policies and guidelines and upload the document at the bottom of this form
Please fill out each form field below
MOTHER'S INFORMATION
FATHER'S INFORMATION
If same as above, just write 'same'
CHILD #1 INFORMATION
CHILD #2 INFORMATION
PERSON NOT AUTHORIZED TO PICK UP CHILD
EMERGENCY CONTACT #1 - OTHER THAN PARENT/GUARDIAN
EMERGENCY CONTACT #2 - OTHER THAN PARENT/GUARDIAN
MEDICAL INFORMATION
CHILD #1 MEDICAL INFORMATION
CHILD #2 MEDICAL INFORMATION
PAYMENT
- Members: Please login to receive the members' tuition discount
- Tuition fees can be paid upfront, or over the course of the year up to 10 payments.
- There is a $50 registration fee.
- There is a $150 deposit fee, which will be returned after the school year assuming that the school did not incur any extra charges as a result of your child(ren).
Please upload your signed POLICIES & GUIDELINES document
Wed, December 19 2018 11 Tevet 5779