Register - ChabadJacksonville.org

Address*

Does your child/ren have any previous Jewish Education?

Yes No Other
Emergency/Medical Information
Emergency Contact #1

First Name Last Name
Phone Number

Area Code Phone Number
Emergency Contact #2

First Name Last Name
Phone Number

Area Code Phone Number
Is your child/children allergic to any foods? If yes, please explain in detail
Is there any special medical or any other information regarding your child/children that our school should be aware of?
Cost

$750
No one will be turned away for lack of funds.

Please contact us at 904-302-6857

Payment

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Billing Address

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

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Terms
As the parent(s) or legal guardian(s) of child/ren noted above, I/we authorize any adult acting on behalf of CKids to hospitalize or secure treatment for my child. I further agree to pay for all charges for that care and/or treatment. It is understood that, if time and circumstances reasonably permit, the staff will try to communicate with me prior to such treatment.

I/we hereby give permission for my child/ren to attend all field trips and outings organized by CKids. I/we hereby give permission for my child/ren to be transported by CKids on field trips.

I/we allow my child/ren to be photographed while participating during school activities. I/we understand that these photographs may be used for publicity purposes.
I Accept the Above Terms*

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Child's Information