JEMS Registration - The Shul - Chabad Lubavitch

JEMS Registration 2021-2022
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
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
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
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*

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

Grandparent 2 Address

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%
Feel free to Check Us Out!
I would like my child to try out one session of JEMS Kids Club free of charge!
Total
$
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

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JEMS Registration 2021-2022