CKids Jewish Discovery Club

Ckids Information Details

Child's First Name *

Child's Last Name *

Child's Jewish Name

Example: David or דוד

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 it’s 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 *

Chabad of the South Hills - Jewish Center for Living & Learning