Ckids Registration

Child's Full Name*

First Name Last Name Hebrew Name

Birth Date*

Month Day Year

Gender*

MaleFemale

Grade entering (2026-27)*

Home Phone*

Area Code Phone Number

Home Address*

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

Is the natural mother of the child Jewish?*

YesNo

Were there any conversions or adoptions in the child's family?*

YesNo

If yes, please explain.

Has your child had any previous Jewish education?*

YesNo

If yes, please explain.

Parents' marital status*

MarriedDivorcedSeparatedWidowed

Father's Name*

First Name Last Name Hebrew Name

Father's Birth Date*

Month Day Year

Father's Email

Father's Cell Phone

Area Code Phone Number

Father's Occupation

Mother's Name*

First Name Last Name Hebrew Name

Mother's Birth Date*

Month Day Year

Mother's Email*

Mother's Cell Phone*

Area Code Phone Number

Mother's Occupation

Person to be contacted in case of an emergency when parents cannot be reached.

Full Name*

First Name Last Name

Phone Number*

Area Code Phone Number

Relationship to child*

Name of Physician*

Physician's Phone Number*

Area Code Phone Number

Confidential: Does your child have any learning or physical disabilities or health challenges?*

YesNo

If yes, please explain.

Allergies

In case of an emergency, I (we) authorize the school to take whatever medical measures they deem necessary for my child in the event of a medical emergency. If a parent or emergency contact cannot be reached, the family physician will be contacted.

Consent:*

I hereby give consent for my child to participate in all CKids activities at Chabad of Old Tappan unless I advise otherwise in writing.Permission is hereby given to use photographs, video, or audio of my child in promoting CKids and other activities directly related to Chabad of Old Tappan.I further agree to indemnify and hold harmless Chabad of Old Tappan and its officers, servants, or assigns from any liability concerning my child's involvement in CKids activities.

Tuition Price*

Optional: Donate to the Scholarship Fund for families in need.

Tuition Agreement*

We agree to pay the full tuition.We are requesting a scholarship.We are requesting a sibling discount of 10%

If you are requesting a scholarship or sibling discount, we will confirm your final tuition before sending your payment form.

Payment Options*

Payment in full upon acceptance.Ten equal monthly payments: the first payment upon acceptance, followed by nine payments on the 1st of each month.

Total

$0.00

Payment Type*

Credit CardCheck

Please submit your registration. Once it has been reviewed and accepted, we will send you a separate payment form with your final total, including any applicable discounts and any Scholarship Fund donation you selected. You can expect to hear from us within 48 hours, and often sooner.

Child's Information

Parent Information

Medical Information

Tuition