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Ckids Information Details
Child's First Name
*
Child's Last Name
*
Child's Jewish Name
Example: David or ืืื
Child's Date of Birth
*
Birth Date Before Sunset (to calculate jewish birthday)
*
Yes
No
Unknown
Grade entering fall 2025
*
Please list any allergies or necessary medical info
*
Mailing Address
*
Parent 1 Name
*
Parent 1 Jewish Name
Parent 1 Phone Number
*
Email
*
Parent 2 Name
Parent 2 Jewish Name
Parent 2 Phone Number
Parent 2 Email
Is the mother Jewish by birth?
*
Yes
No
Is the father Jewish by birth?
*
Yes
No
Have there been any adoptions or conversions in the family (e.g., the child, parents, grandparents)?
*
Yes
No
If yes, please explain and indicate which synagogue the conversion took place:
Emergency Contact Name & Phone Number
*
Relation
*
*Disclaimer* Please note: Your child is not registered in CKIDS JDC until you receive an acceptance confirmation phone call or email. As the parent(s) or legal guardian of the above child/ren, I/we authorize any adult acting on behalf of Chabad of the South Hills to hospitalize or secure treatment for my/our child/ren, I/we further agree to pay all charges for that care and/or treatment. It is understood that if time and circumstances reasonably permit, Chabad of the South Hills personnel will try, but are not required, to communicate with me/us prior to such treatment. I/we hereby give permission for my/our child/ren to participate in all school activities, join in class and school trips on and beyond school properties and allow my/our child/ren to be photographed while participating in Hebrew School activities. I/we also understand that all liability and costs resulting from damage to property and/or personal injury caused or attributable to my/our child/children will be my/our responsibility and I/we agree to fully indemnify and save Chabad of the South Hills and itโs associates, teachers and agents harmless therefrom. I/we consent to Chabad of the South Hills use of our personal information and of our child/children at its discretion in pursuit of school activities. Tuition refunds will not be granted to children withdrawing from school. There are no refunds or credits for days missed due to illness, holidays, or family vacations. I understand that if my child behaves dangerously or bullies another child they will be removed from the program.
Digital Signature
*
Use this space to share anything you would like us to know about your child and what you would like your child to gain at JDC this year!
Email to send confirmation to
*
Fees
CKids JDC Fee
Yearly Fee
-
$ 650.00
Early bird through August 20
-
$ 500.00
No synagogue membership required! No child will be turned away due to lack of funds, please email hindy@chabadsh.com for discreet inquiries.
Total
Payment Options
Payment Method
Credit Card
I will send payment by check
Review
Chabad of the South Hills - Jewish Center for Living & Learning
rabbi@chabadsh.com
|
412-344-2424
|
1701 McFarland Road Pittsburgh, PA 15216-1812
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