Jew Crew Jr.
Sign up for Middle School Afterschool Jewish Club!
My child is a... *
Child's First Name *
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Child's Last Name *
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Child's Hebrew Name (if it is different than Child's Name)
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Mother's Hebrew Name *
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Parent or Legal Guardian's Name *
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Parent or Legal Guardian's Cell Phone Number *
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Parent or Legal Guardian's Email *
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Confirm Parent or Legal Guardian's Email *
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Home Address *
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Child's Birthday *
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Child's School and Class *
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My Child is in... *
Child's Cell Phone (if he/she has one)
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Emergency Contact Person *
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Emergency Contact Number *
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Any Medical Issues, Condition or Allergies *
Please write "None" or specify which condition your child has.
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Transportation *
Do you let your child walk to and from the program by themselves?
Jewish: *
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Comments, Suggestions or Requests?
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Permission *
By checking the box below, I agree that I am a parent or legal guardian of the above written child, and that I give my child permission to participate in the learning and activities of the Jewish After School Club which is run by Rabbi Eli Blokh and Rabbi Yaakov Horvitz . I also give them permission to take photos/videos of my child and to post them on their Facebook page or the like. I give my children permission to be transported in private vehicles to/from the program, school and home.
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