This form is currently closed. 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 CodePlease SelectUnited StatesAfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanThe BahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChilePeople's Republic of ChinaRepublic of ChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongoCook IslandsCosta RicaCote d'IvoireCroatiaCubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonThe GambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorthern MarianaNorwayOmanPakistanPalauPanamaPapua New GuineaParaguayPeruPhilippinesPitcairn IslandsPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint BarthelemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSomalilandSouth AfricaSouth OssetiaSpainSri LankaSudanSurinameSvalbardSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTristan da CunhaTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamBritish Virgin IslandsUS Virgin IslandsWallis and FutunaWestern SaharaYemenZambiaZimbabweOther 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* 1 - January2 - February3 - March4 - April5 - May6 - June7 - July8 - August9 - September10 - October11 - November12 - December Month12345678910111213141516171819202122232425262728293031 Day202020192018201720162015201420132012201120102009200820072006200520042003200220012000 Year 1 Grade Entering 1 School Attending 1 Previous Jewish Education? 1 Hebrew reading proficiency NoneSomewhatWell 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* 1 - January2 - February3 - March4 - April5 - May6 - June7 - July8 - August9 - September10 - October11 - November12 - December Month12345678910111213141516171819202122232425262728293031 Day202020192018201720162015201420132012201120102009200820072006200520042003200220012000 Year 2 Grade Entering 2 School Attending 2 Previous Jewish Education? 2 Hebrew reading proficiency NoneSomewhatWell 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 messaging? iMessage/textWhatsapp 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 Form Date Month Day Year Discount Code If any Discount - Full Total $ USD $50.00 I would like to pay today:Full amount$50.00 minimum$ Choose Payment Option Includes $50 deposit and reflects discount of 25% Entire Year Registration - $731 Choose Payment Option Includes $50 deposit and reflects discount of 25% 2nd Sibling Entire Year Registration - $682 Choose Payment Option* Includes $50 deposit and reflects discount of 20% Entire Year Registration - $780 Choose Payment Option* Includes $50 deposit and reflects discount of 20% 2nd Sibling Entire Year Registration - $731 Choose Payment Option* Includes $50 deposit and reflects discount of 18% Entire Year Registration - $8003 Installments - $267 Choose Payment Option* Includes $50 deposit and reflects discount of 18% 2nd Sibling Entire Year Registration - $7512nd Sibling in 3 Installments - $251 Choose Payment Option* Includes $50 deposit and reflects discount of 10% until August 1, 2025 Entire Year Registration - $8783 Installments - $293 Choose Payment Option* Includes $50 deposit and reflects discount of 10% until August 1, 2025 2nd Sibling Entire Year Registration - $8292nd Sibling in 3 Installments - $277 Choose Payment Option* Includes $50 deposit and reflects discount of 5% until August 31, 2025 Entire Year Registration - $9273 Installments - $309 Choose Payment Option* Includes $50 deposit and reflects discount of 5% until August 31, 2025 2nd sibling Entire Year Registration - $8782nd Sibling in 3 Installments - $293 Choose Payment Option* Entire Year Registration - $9753 Installments - $325 Choose Payment Option* 2nd sibling Entire Year Registration - $9272nd Sibling in 3 Installments - $309 Choose Payment Option* Includes $50 deposit and reflects discount of 17% Entire Year Registration - $8183 Installments - $273 Choose Payment Option* Includes $50 deposit and reflects discount of 17% 2nd sibling Entire Year Registration - $7722nd Sibling in 3 Installments - $258 The next installment is due by September. Payment Credit Card Check Credit Card We accept Visa, MasterCard, American Express, Discover Credit Card Number Security Code Name on Card1 - January2 - February3 - March4 - April5 - May6 - June7 - July8 - August9 - September10 - October11 - November12 - December Expiration Month2026202720282029203020312032203320342035 Expiration YearCheck can be made payable and mailed to Chabad of Rancho Mirage • 72-295 Via Marta • Rancho Mirage, CA 92270Billing Address Street Address City State / Province Postal / Zip CodePlease SelectUnited StatesAfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanThe BahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChilePeople's Republic of ChinaRepublic of ChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongoCook IslandsCosta RicaCote d'IvoireCroatiaCubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonThe GambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorthern MarianaNorwayOmanPakistanPalauPanamaPapua New GuineaParaguayPeruPhilippinesPitcairn IslandsPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint BarthelemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSomalilandSouth AfricaSouth OssetiaSpainSri LankaSudanSurinameSvalbardSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTristan da CunhaTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamBritish Virgin IslandsUS Virgin IslandsWallis and FutunaWestern SaharaYemenZambiaZimbabweOther Country Should be Empty: This page uses TLS encryption to keep your data secure.
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