Kids Form | Jewish VA Beach

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We are currently accepting application forms for the upcoming Kids Club Programs, Space is limited.

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

Childs information:

First Name

Last Name

Hebrew Name

Date of birth

Hebrew name

previous Jewish Education

Yes

If yes, please name the school

Parents information:

father's first name

father's last name

father's Cell

mother's first name

mother's Cell

Select an Address

father's Email

mother's last name

mother's Email

Home Phone

Were there any conversions or adoptions in the family?

Yes

I hereby give permission for my child to be photographed. Photos may be used for promotional purposes for Chabad / Jewish Virginia Beach*

Emergency information:

emergency contact

Phone

Does your child(ren) have any allergies or other medical condition we should be aware of?

Yes

If yes, please describe the condition and indicate special precautions or care needed

MEDICAL AGREEMENT

As the parent(s) or legal guardian of the above child, I/we authorize any adult acting on behalf of Chabad /Jewish Kids Club to hospitalize or secure treatment for my child, I further agree to pay all charges for that care and/or treatment. It is understood that if time and circumstances reasonably permit, Chabad / Jewish Virginia Beach personnel will try, but are not required, to communicate with me prior to such treatment. I hereby give permission for my child to participate in all school activities, join in class and school trips on and beyond school properties and allow my child to be photographed while participating in Chabad / Jewish Kids Club activities and that these pictures may be used for marketing purposes.

today's date

Your Signature as agreement

If you are in a position to contribute to our scholarship fund, please consider giving us the option to sponsor another child and gift him with a sponsored Jewish education by choosing the full cast option

select a payment option