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Registration Form for Passport to Jewish Learning 2018-19

    Passport to Jewish Learning (K-1) Member Rate $525.00
    Passport to Jewish Learning (K-1) Non-Member Rate $675.00
   Passport to Jewish Learning (2-5) Member Rate $675.00
   Passport to Jewish Learning (2-5) Non-Member Rate $850.00
   Bnei Mitzvah (Grades 6-7) $475.00 No Judaic Class
   Bnei Mitzvah (Grades 6-7) $575.00 with Judaic Class
   Bnei Mitzvah (Grades 6-7) $675.00 with Judaic and Tefillah Skills Class
   Kadima Youth Group (Grades 6-8) $125.00 per student


   $50.00 Early Bird (until 8.1.18)
   $100.00 (after 8.1.18)

Student 1

   None at this time
   Specific physical condition/illness past or present (e.g. cerebral palsy epilepsy asthma diabetes...)
   Allergy (e.g. insect sting pollen food drugs...)
   Vision/Eye
   Hearing/Ear
   Speech (e.g. delay stuttering difficulty understanding speech ...)
   Learning or Perceptual Problems (in particular difficulty learning to read phonetically)
   Gross Motor or Fine Motor
   Attention Deficit Disorder with/without Hyperactivity
   Special Dietary Needs
   My child is taking regular medications...
   Behavior/Personal Relationships (e.g. easily upset shy difficulty making friends ...)

Student 2

   None at this time
   Specific physical condition/illness past or present (e.g. cerebral palsy epilepsy asthma diabetes...)
   Allergy (e.g. insect sting pollen food drugs ...)
   Vision/Eye
   Hearing/Ear
   Speech (e.g. delay stuttering difficulty understanding speech ...)
   Learning or Perceptual Problems (in particular difficulty learning to read phonetically)
   Gross Motor or Fine Motor
   Attention Deficit Disorder with/without Hyperactivity
   Special Dietary Needs
   My child is taking regular medications...
   Behavior/Personal Relationships (e.g. easily upset shy difficulty making friends ...)

Student 3

   None at this time
   Specific physical condition/illness past or present (e.g. cerebral palsy epilepsy asthma diabetes...)
   Allergy (e.g. insect sting pollen food drugs ...)
   Vision/Eye
   Hearing/Ear
   Speech (e.g. delay stuttering difficulty understanding speech ...)
   Learning or Perceptual Problems (in particular difficulty learning to read phonetically)
   Gross Motor or Fine Motor
   Attention Deficit Disorder with/without Hyperactivity
   Special Dietary Needs
   My child is taking regular medications...
   Behavior/Personal Relationships (e.g. easily upset shy difficulty making friends ...)

Student 4

   None at this time
   Specific physical condition/illness past or present (e.g. cerebral palsy epilepsy asthma diabetes...)
   Allergy (e.g. insect sting pollen food drugs ...)
   Vision/Eye
   Hearing/Ear
   Speech (e.g. delay stuttering difficulty understanding speech ...)
   Learning or Perceptual Problems (in particular difficulty learning to read phonetically)
   Gross Motor or Fine Motor
   Attention Deficit Disorder with/without Hyperactivity
   Special Dietary Needs
   My child is taking regular medications...
   Behavior/Personal Relationships (e.g. easily upset shy difficulty making friends ...)

Parents Information


Emergency Contact Information

PLEASE NOTE: In addition to completing this form to register your child(ren) for the 2018/2019 school year, we ask that you complete the Tuition Commitment Form, Emergency Contact Form, and Release Form. The Tuition Commitment Form must be received by August 1, 2018 in order to pay the $50 registration fee. After August 1, the registration fee is $100. All other required forms are due by August 1. Again, please give us a call if you have any questions at 303-399-0035. Thank you so much.

Wed, March 20 2019 13 Adar II 5779