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Please fill out ALL fields of this form. If you have any questions or concerns you'd like to discuss, please contact us.

We look forward to a wonderful year of learning and growth.
One registration form is needed per child.

* First Name

* Last Name

Hebrew Name

* Gender

* Grade Entering

* My Child

Please Select OneDoes not read HebrewRecognizes letters of the Alef-BetCan read Hebrew slowlyCan read Hebrew very well

* My child's knowledge of basic Judaism:

Please Select OneGoodFairPoor

* Does your child have any physical/mental conditions we should be aware of?

* Are the child's biological parents Jewish by birth?

Please Select OneYesNo

If no, please explain:

* Have there been any conversions or adoptions in your family?

Please Select OneYesNo

If yes, please explain:

* Address

* City

* State

* Zip Code

* Father's First Name

* Last Name

* Phone Number

* Email

* Mother's First Name

* Last Name

* Phone Number

* Email

* In case of an emergency and the parents cannot be contacted, please contact:

* Phone Number

* Relationship

* Tuition Type

Please Select OneNon-Member Tuition | $1,100CBI Member Tuition | $1,000

* Payment

Please Select One10 Equal Payments (charge to my account)Pay in full (charge to my account)
Please note: On July 1, 2024 both full payments and installment plans will be initiated. It is imperative that tuition be settled entirely by the culmination of the JUDA school year (April 31, 2025).

Wed, May 1 2024 23 Nisan 5784

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