Yes! I'd like to Re-Register my child/ren for the Jewish U for Kids Hebrew School for 2012/13
Last Name    


First Name (Child 1)      
Jewish Name   Birth Date

First Name (Child 2)      
Jewish Name   Birth Date
Parent Name      
Home Address   Home Phone
Mom's cell   Dad's Cell
Email Mom   Email Dad
Billing Information



(10% Early bird discount if paid in full by July 1 st. 5% Sibling Discount)


Charge Amt.

(Discounts included - Until June 10) 

Address   CC Type
City/State/Zip   Card #:
Phone   Exp. Date
Email   CVV
If there are any changes in the information recorded on the registration form, please enter: (i.e. new siblings, doctor, business, emergency contacts, etc.)