Register 2022-2023

Welcome! We are currently accepting application forms for 2022-2023.

1st Semester: September 14th- January 11th

2nd Semester: January 18th- May 31st

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If you have any questions or concerns you'd like to discuss with us, please contact us at 412-708-2734.

Please note that a separate registration form is needed for each child that is applying.

We look forward to a wonderful year of learning and growth.

Full 2022-2023 JEC Calendar- coming soon!

I would like to register my child for*

1st Semester 2nd Semester Both

Child's Name*

First Name Middle Name Last Name

Hebrew Name*

Birth Date*

Month Day Year

Time of Birth or Jewish Birthday*

Gender*

Male Female

Grade*

School*

Previous Jewish Education

Yes No

Where?

Hebrew Reading Proficiency

None Somewhat Well

CONFIDENTIAL: Does your child have an IEP or other learning challenges? If yes, please describe them and indicate special precautions or care needed.

What are your goals in terms of your child's experience at Jewish Enrichment Club? Please number each line with numbers 1 to 5. (1=top priority), and add your own to the list. (0=not a priority) Thank you!

Address*

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

Parent/Guardian 1*

First Name Last Name

Parent/Guardian 1 Cellphone*

Area Code Phone Number

E-mail* Primary email

Marital Status*

Married Single Divorced/Seperated

Parent/Guardian 2

First Name Last Name

Parent/Guardian 2 Cellphone

Area Code Phone Number

Parent/Guardian 2 E-mail

Is the birth mother and maternal grandmother of the child Jewish?*

Yes No

Have there been any conversions or adoptions in the family? If yes, please explain.

How did you hear of us?*

Emergency Contact*

First Name Last Name

Phone Number*

Area Code Phone Number

Relationship*

Pediatrician*

First Name Last Name

Phone Number

Area Code Phone Number

Medical Insurance*

Policy #*

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

Full Name*

First Name Last Name

Date*

We look forward to a wonderful year of fun, learning and growth!

After you have successfully submitted your application it will be subject to review. We will reach out to schedule a follow up call to discuss your application and confirm it's approval. Once approved a link will be sent to submit tuition to complete your child's enrollment.

General Comments

Child's Profile

Family Information

Emergency Contact Information

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