Ckids Academy Registration – Anshei Lubavitch

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Are you enrolling in the middle?*

Yes
No

Dates of enrollment

What week do you plan on entering?

Family details

Family Name*

Father's First Name*

Father's Cell Number*

Father's Place of Work*

Father's Work Number*

Father's Email Address*

Mother's First Name*

Mother's Cell Number*

Mother's Place of Work*

Mother's Email Address*

Home Address*

Street Address ZIP / Postal Code

Is mother born Jewish?*

Yes
No

Which groups are you registering for?*

CKIDS Academy Jr. Grades K-1st
CKIDS Academy Grades 2nd-5th
CTEEN Jr. Academy Grades 6th-8th

Child 1 Name*

First

Child 1 Hebrew Name

Child 1 Birthday*

Child 1 School*

Child 1 Allergies

Would you like to enroll a second child?*

Yes
No

Child 2

Child 2 Name

First

Child 2 Hebrew Name

Child 2 Birthday

Child 2 School

Child 2 Allergies

Would you like to enroll a third child?*

Yes
No

Child 3

Child 3 Name

First

Child 3 Hebrew Name

Child 3 Birthday

Child 3 School

Child 3 Allergies

Payment

Late registration fee for 1 child

Price: $0.00

Late registration fee for 2 children

Price: $0.00

Late registration fee for 3 children

Price: $0.00

Registration fee for 1 Child – $1200.00*

Price:

Total of $1200.00 It will be divided into quarterly payments of $300

Registration fee for 2 Children – $2400.00*

Price:

Total of $2400.00 It will be divided into quarterly payments of $600

Registration fee for 3 Children – $3600.00*

Price:

$3,600.00 It will be divided into quarterly payments of $900.00

Total

$0.00

Credit Card

American Express

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MasterCard

Visa

Card Number Expiration Date Security Code Cardholder Name