After School Registration

Full Name*

First Name Last Name

Hebrew Name (if he/she has one)

Birth Date*

Month Day Year

Does your child have previous Jewish Education?*

YesNo

If yes, please describe:

School*

Grade entering*

Is it ok for your child to travel in a teachers' car?*

YesNo

Any considerations, such as learning disorder or difficulty, the school should be aware of? (Confidential):

Address*

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

Days you want to send your child*

Which session you want to send your child?*

Add another child?

Yes

Full Name*

First Name Last Name

Hebrew Name (if he/she has one)

Birth Date*

Month Day Year

Does your child have previous Jewish Education?*

YesNo

If yes, please describe:

School*

Grade entering*

Is it ok for your child to travel in a teachers' car?*

YesNo

Any considerations, such as learning disorder or difficulty, the school should be aware of? (Confidential):

Address*

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

Days you want to send your child*

Which session you want to send your child?*

Add another child?

Yes

Full Name*

First Name Last Name

Hebrew Name (if he/she has one)

Birth Date*

Month Day Year

Does your child have previous Jewish Education?*

YesNo

If yes, please describe:

School*

Grade entering*

Is it ok for your child to travel in a teachers' car?*

YesNo

Any considerations, such as learning disorder or difficulty, the school should be aware of? (Confidential):

Address*

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

Days you want to send your child*

Which session you want to send your child?*

If you wish to add another child, please submit a new form or contact [email protected]

Father's Name*

First Name Last Name

Cellphone

Area Code Phone Number

Home Phone

Work Phone

E-mail

Occupation

Mother's Name*

First Name Last Name

Cellphone

Home Phone

Work Phone

E-mail

Occupation

Is the child's mother Jewish by birth or by choice?

By birthBy choice

Best way to send After School Updates*

Cell PhoneEmail

Would you like to contribute to afterschool activities with your time or talents?

YesNo

Emergency Contact (NOT living with you)*

First Name Last Name

Relationship to child*

Address*

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

Work/Cell*

Home Phone*

Child's Physician or Medical Facility*

Physician's Phone*

Physician's Address*

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

I hereby give permission for my child to participate in all school activities, join in class and school trip on and beyond school properties and allow my child to be photographed while participating in CKids After School activities.

As the parent(s) or legal guardian of the above child, I/we authorize any adult acting on behalf of CKids After School 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, CKids After School personnel will try, but are not required, to communicate with me prior to such treatment.

Parental Consent

Accept

Transportation
Once your registration form is submitted, We will reach out to you regarding daily transportation from your child's school to our location.

Thank you for registering! Our office will be in contact with you shortly regarding payment.

I would like to receive news and updates by email

Register

After School Program Registration

Child Information

Parents Information

Emergency Contact Information

Thank you for registering! Our office will be in contact with you shortly regarding payment.