We are currently accepting application forms for the 2018-2019 school year. Please fill out ALL fields of this form. If you have any questions or concerns you'd like to discuss with us, please contact us.

One registration form per child is needed.

First & Last Name   Hebrew Name
Age   D.O.B.
School   Grade Entering
Address   Apt.
City, State, Zip
City State Zip
  Home Phone
Child's Cell Phone   Child's Email
Name of Sibling: 1.   Age:
2.   Age:

Father's Name   Religion
Occupation   Business Name
Address   City, State, Zip
City State Zip
Email   Cell
Father Facebook      
Mother's Name   Religion
Occupation   Business Name
Address   City, State, Zip
City State Zip
Email   Cell

Mother Facebook      
CONFIDENTIAL:      Is the mother of the child Jewish?  Yes  no

Is the father of the child Jewish?  Yes  no

Were there any conversions or adoptions in the family? no yes

If Yes, please describe:
Marital Status of Parents: Married Separated Divorced - How long?
What goals do you have for your child attending Jewish Kids Club?

Please share any other information you feel is important for Jewish Kids Club to be aware of. This can include exceptional behavior, concerns, particular activities, family relationships etc.


Please list below two emergency contacts
Emergency Contact 1   Relation to Child
Phone   Business Phone
Emergency Contact 2   Relation to Child
Phone   Business Phone

CONFIDENTIAL: Does your child have any allergies or other medical condition we should be aware of? If yes, please describe them and indicate special precautions or care needed.

Doctor's Name   Doctor's Phone
Doctor's Address   City, State, Zip
City State Zip

Permission for Emergency Medical Treatment:

As the parent(s) or legal guardian of I/we authorize any adult acting on behalf of Jewish Kids Club to hospitalize or secure treatment for my child. I further agree to pay all charges for that care and/or treatment. It is understood that if time and circumstances reasonably permit, Jewish Kids Club personnel will try, but are not required, to communicate with me prior to such treatment.

I hereby give permission for my child to attend all field trips and outings sponsored by Jewish Kids Club.


Yearly tuition rates:

$4,500 for 5 days a week ($450 monthly)

$4,100 for 4 days a week ($410 monthly)

$3,600 for 3 days a week ($360 monthly)

$2,700 for 2 days a week ($270 monthly)

$1,900 for 1 day a week ($190 monthly)

For all students who are NOT in PS100, there is a transportation fee: $40 monthly fee for once or twice a week, $75 monthly fee for 3-5 times a week.

Please select which days your child will be attending:
Monday Tuesday Wednesday Thursday Friday

For questions, comments or discounted rates, contact us at

Payment options: (Please check off one.)

Pay by check on the first day of each month.   

Pay by check on the first day of JKC with the entire year's tuition (to receive 5% off!)

Pay online now and we will charge the same card on the first day of every month.
     (You’ll be charged a small fee for credit card processing.)  

Enter promo code:  

In order to complete your child's registration:
- submit full payment for (at least) September
- email updated health form to
- wait for confirmation that your child is accepted
If you have any questions or concerns, feel free to contact us:

I understand that by submitting this form I am committing to pay the above outlined tuition fees.

Name: Initials: Date:

Billing Name (First) iiiiiiiiiiiiiiiiiiiiiiLast Name iiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiBilling Address - Street
Card NumberiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiCVV CodeiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiExpirationiiiiiiiiiiiiiiiiiiiTotal $ to Charge Card
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To apply for a scholarship, please click here