Printed from ChabadCarnegie.com
ב"ה

JUDA Registration Form

  • Child Information

  • Parent Information

  • Emergency Information

  • Declaration of Parent / Guardian

    I hereby authorise Chabad Carnegie leaders and staff to obtain any medical care necessary for my child. I understand that in the case of emergency of any significant illness or injury, attempt will be made to contact myself when practical. I agree to pay for any cost that may occur as a result of the injury/illness. I acknowledge my child may be participate in activities within and outside the Chabad grounds. I authorise my child to participate in these activities. I hereby authorize Chabad Carnegie to photograph my child and to use the photographs at their discretion.

  • In order to secure your place, a $100 non-refundable deposit is necessary.   

    I understand that the Application fee of $100 is the first installment of payment and and is on the basis of completing the full year program. I authorise JUDA club (Chabad Carnegie) to charge my credit card accordingly.  I understand that the Application fee of $100 is non-refundable.

    I also give Chabad Carnegie permission to debit $180 Fee per child at the beginning of each term from the credit card below. If this is an issue please contact us prior to the start of the year to make other arrangements. 

  • Credit Card
  • Should be Empty:
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