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Parent's Info
Mother's Name
First Name Last Name
Hebrew Name If available
Home

Area Code Phone Number
Cell

Area Code Phone Number
Do you have Whatsapp Messenger Service?
E-mail
Father's Name
First Name Last Name
Hebrew Name If available
Home

Area Code Phone Number
Cell

Area Code Phone Number
Do you have Whatsapp Messenger Service?
E-mail

Address

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

Are the natural father, mother and maternal grandmother of the child Jewish?*

YesNo
Have there been any conversions or adoptions in the family?*

YesNo
Did someone refer you? How did you find out about our program?
Child's Info
For how many child/children
1 Child's Name*
First Name Last Name
1 Hebrew Name If available
1 Birth Date*

Month Day Year
1 Grade Entering
1 School Attending
1 Previous Jewish Education?
1 Hebrew reading proficiency
1 Any special learning, behavioral needs or any family or living issues?
1 Additional Comments
2 Child's Name*
First Name Last Name
2 Hebrew Name If available
2 Birth Date*

Month Day Year
2 Grade Entering
2 School Attending
2 Previous Jewish Education?
2 Hebrew reading proficiency
2 Any special learning, behavioral needs or any family or living issues?
2 Additional Comments
Emergency Information & Terms
In the rare case that there is an emergency and we cannot reach either parent, please let us know who we can contact.
Emergency Contact 1
First Name Last Name
Home

Area Code Phone Number
Cell

Area Code Phone Number
Emergency Contact 2
First Name Last Name
Home

Area Code Phone Number
Cell

Area Code Phone Number
Doctor's Name
First Name Last Name
Doctor's Number

Area Code Phone Number
Allergies or other Medical Condition
What is your preference for reminder messageing?
Click to edit
Agreement
As parent(s) or legal guardian of the above child, I/we authorize any adult acting on behalf of Ckids Hebrew School/Chabad of Rancho Mirage to hospitalize or secure treatment for my child. This includes all medical transportation, medical and surgical treatment, X-ray, laboratory, anesthesia, and other medical and/or hospital procedures which may be performed or prescribed by the attending physician and/or paramedics for my child and waive my right to informed consent of treatment. I further agree to pay all charges for that care and/or treatment. This waiver applies only in the event that neither parent/guardian can be reached in the case of an emergency.

I allow my child to be photographed and for the photos to be used in print, video and digital media.

I hereby give permission for my child to attend all field trips and outings sponsored by CKids Hebrew School.
Agreement*

I have read the terms and conditions as laid out above and accept.
Amount to Charge
I'm interested in finding out about tuition scholarship opportunities
$50 down payment. Upon acceptance you will receive a contract. See Dates & Rates for total tuition fees.
Registration - $50
Discount Code If any
Discount - Scholar
Discount - Full
Total $ USD

$0.00

I would like to pay today:Full amount$50.00 minimum$
Choose Payment Option Includes $50 deposit and reflects discount of 20% until June 30, 2024

Entire Year Registration - $6702nd sibling Entire Year Registration - $625
Choose Payment Option Includes $50 deposit and reflects discount of 18% until July 7, 2024

Entire Year Registration - $6883 Installments - $2302nd sibling Entire Year Registration - $6432nd Sibling in 3 Installments - $215
Choose Payment Option* Includes $50 deposit and reflects discount of 15%

Entire Year Registration - $7153 Installments - $2392nd sibling Entire Year Registration - $6772nd Sibling in 3 Installments - $226
Choose Payment Option* Includes $50 deposit and reflects discount of 10%

Entire Year Registration - $7603 Installments - $2542nd sibling Entire Year Registration - $7202nd Sibling in 3 Installments - $240
Choose Payment Option Includes $50 deposit and reflects discount of 5% until August 30, 2024

Entire Year Registration - $8053 Installments - $2692nd sibling Entire Year Registration - $7632nd Sibling in 3 Installments - $254
Choose Payment Option*

Entire Year Registration - $8503 Installments - $2842nd sibling Entire Year Registration - $8052nd Sibling in 3 Installments - $269
The next installment is due by September.

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Educate Your Child... Educate a Generation

Parent's Info

Child's Info

Emergency Information & Terms

Agreement

Amount to Charge