Jewish Kids Club
Registration Form


General Information
Child Name Hebrew Name
Child Name Hebrew Name
Child Name Hebrew Name
Address Phone
City/State/Zip Email  
Parents Information
Mothers Name Fathers Name
Mothers Email Fathers Email
Emergency Information
Emergency Contact Phone
Billing Details: $120 Per Child for year, $15 Per Session
$ Card Type*
First Name Last Name
Card Number* Expiration Date*
CVV* (Check if same as address)
Billing Address

Please carefully review the information you provided, then press Submit (once only). Please wait a few seconds for acknowledgement online that your information was received.