Register - Chabad of Bradenton

Welcome! We are thrilled you are considering joining the CKids After School Club. Space is limited, and acceptance is prioritized for students and alumni of the Chabad Hebrew School of the Arts and those affiliated with The Chabad House.
Parents Information
Father's Name*
First Name Last Name
Cell Phone Number*
Home Phone Number
Work Phone Number
E-mail*
Occupation
Mother's Name*
First Name Last Name
Cell Phone Number*
Work Phone Number
E-mail*
Occupation
Is the child's mother Jewish?*

Yes (if adopted/converted, please specify below)No
Is the child's father Jewish?*

Yes (if adopted/converted, please specify below)No
Are there any adoptions in your family (children, parents or grandparents)?*

YesNo
Have you or your spouse, parents, grandparents or children ever converted to Judaism?*

YesNo
Please include all specifics here if applicable:
Best way to send After School Updates*

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

YesNo
Child Information
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
Please describe:
School*
Grade entering*
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

Emergency Contact Information
Emergency Contact Information
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 Phone*

Physician's Address*

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

Consent and Payment
$30 non-refundable registration fee per child
Legal & Consent Text:

Please note that tuition remains the same regardless of holidays, vacations, sickness, and closings beyond our control. Parents who wish to withdraw their child from the program are required to provide a one-week notice in writing to the Afterschool Services Coordinator at chanie@chabadofbradenton.com.I authorize any adult acting on behalf of the Ckids Afterschool 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, Ckids Afterschool will try to communicate with me prior to such treatment.Whenever photographs of minors attending Ckids Afterschool are published on the website & facebook, we ensure that no child’s name or personal information will be published with its picture. I am providing consent for the Ckids Afterschool to publish photographs, audio recordings and/or video footage of my child for their website, social media and marketing print material.
Please select:*

Annual PaymentSession-Based PaymentMonthly Payment
Current CHS student?*

YesNo
Annual Payment Options:*

In full for four-day weekIn full for two-day weekIn full for four-day week with after school plusIn full for two-day week with after school plus
Monthly Payment Options:*

Monthly (prorated) for four-day week (divided equally over 10 months)Monthly (prorated) for two-day week (divided equally over 10 months)Monthly (prorated) for four-day week with after school plus(divided equally over 10 months)Monthly (prorated) for two-day week with after school plus(divided equally over 10 months)
Annual Payment Options: (CHS Student)*

In full for four-day weekIn full for two-day weekIn full for four-day week with after school plusIn full for two-day week with after school plus
Monthly Payment Options:(CHS Student)*

Monthly (prorated) for four-day week (divided equally over 10 months)Monthly (prorated) for two-day week (divided equally over 10 months)Monthly (prorated) for four-day week with after school plus(divided equally over 10 months)Monthly (prorated) for two-day week with after school plus(divided equally over 10 months)
IF SESSIONS-BASED OPTION WAS CHOSEN, PLEASE SPECIFY:

Session for two daysSession for four daysSession for two days with After School PlusSession for four days with After School Plus
Please select a session:(CHS Student, 2 days)* CHS Student, Two days

Session 1Session 2Session 3Session 4Session 5
Please select a session:(CHS Student, 2 days with Plus)* CHS Student, Two days with After School Plus

Session 1Session 2Session 3Session 4Session 5
Please select a session:(CHS Student, 4 days)* CHS Student, Four Days

Session 1Session 2Session 3Session 4Session 5
Please select a session:(CHS Student, 4 Days with Plus)* CHS Student, Four Days with After School Plus

Session 1Session 2Session 3Session 4Session 5
Please select a session:(2 days)* Two Days

Session 1Session 2Session 3Session 4Session 5
Please select a session:(2 days with Plus)* Two Days with After School Plus

Session 1Session 2Session 3Session 4Session 5
Please select a session:(4 days)* Four Days

Session 1Session 2Session 3Session 4Session 5
Please select a session:(4 days with Plus)* Four Days with After School Plus

Session 1Session 2Session 3Session 4Session 5
Total

$0.00

Payment

Credit Card Paypal Check

Postal / Zip Code

Country

Should be Empty:

Welcome! We are thrilled you are considering joining the CKids After School Club. Space is limited, and acceptance is prioritized for students and alumni of the Chabad Hebrew School of the Arts and those affiliated with The Chabad House.

Parents Information

Child Information

Emergency Contact Information

Consent and Payment