JEMS Registration - The Shul - Chabad Lubavitch

We are currently accepting application forms for the 2021-22 school year. Please fill out ALL fields of this form. If you have any questions or concerns you'd like to discuss with us, feel free to contact Rabbi Yishai at 248-390-5711 or email [email protected]

Child Profile:

Child 1 Full Name*

First NameLast Name

Child 1 Hebrew Name

Child 1 Age*

Child 1 Birth Date*

MonthDayYear

Child 1 School*

Child 1 Grade Entering*

Child 1 Previous Jewish Education if applicable

Child 2 Full Name

First NameLast Name

Child 2 Hebrew Name

Child 2 Age

Child 2 Birth Date

MonthDayYear

Child 2 School

Child 2 Grade Entering

Child 2 Previous Jewish Education if applicable

Child 3 Full Name

First NameLast Name

Child 3 Hebrew Name

Child 3 Age

Child 3 Birth Date

MonthDayYear

Child 3 School

Child 3 Grade Entering

Child 3 Previous Jewish Education if applicable

Parent Information:

Address*

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

Father's Name*

First NameLast Name

Father's Cell Number*

Area CodePhone Number

Father's E-mail*

Mother's Name*

First NameLast Name

Mother Born Jewish?*

YesNoConverted

Mother's Cell Number*

Area CodePhone Number

Mother's E-mail*

Emergency Information:

Emergency Contact*

First NameLast Name

Phone Number*

Area CodePhone Number

CONFIDENTIAL: Does your child have any allergies or other medical condition that we should be aware of? If yes, please describe them and indicate special precautions or care needed.

Please specify:

Grandparent Information:

We LOVE sharing smiles with the Grandparents. Help us spread Nachat by sharing the following information:

Grandparent 1 Name

First NameLast Name

Grandparent 1 Address

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

Grandparent 1 E-mail

Grandparent 2 Name

First NameLast Name

Grandparent 2 Address

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

Grandparent 2 Email

Payment :

We never turn down a family for financial reasons. Please be in touch with us to discuss scholarship options.

Full Tuition - $600
Subsidized Tuition - $550
Sponsor another child too! - $1200
Sibling Discount - 10%
NEW student special - 15%

Bar Mitzvah class extension - additional $200

How would you like to pay

Pay entire amount now6 month payment plan

Feel free to Check Us Out!

I would like my child to try out one session of JEMS Kids Club free of charge!

Total payment to be charged now

$

Optional Lunch n' Learn

Please count my child in for 12-12:30 Lunch n' Learn (Begins in October)Please keep me posted for Lunch n' Learn Opportunities for PARENTS!

Payment

Credit Card

Credit Card Type
Credit Card Number
Name on Card
Expiration Month	Expiration Year

JEMS Registration 2021-2022

Child 1

Child 2

Child 3