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GROW After-School Enrichment Program

Register New Student

GROW Registration 2018-2019
Please fill out a separate form for each child
RETURNING STUDENTS CLICK HERE
Child's Name*
First NameLast Name
Hebrew Name*
Birth Date*
MonthDayYear
School*
Grade entering*

Address*

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Does your child have any medical, developmental or behavioral issue that we should know about? Please Describe:
Additional notable Information
Parents Information
Father's Name
First NameLast Name
Father's Email
Father Cell*
Area CodePhone Number
Father's Hebrew Name
Mother's Name*
First NameLast Name
Mother's Email*
Mother Cell*
Area CodePhone Number
Mother's Hebrew Name*
Emergency Contact*
First NameLast Name
Emergency Contact Phone*
Area CodePhone Number
Were there any conversions in the family?*
YesNo
If yes, who was the Rabbi?
Was the child born Jewish?*
YesNo
Does Your Child Have Any Allergies?
YesNo
If yes, please specify allergies
Permission for Emergency Medical Treatment*
As the parent(s) or legal guardian, I/we authorize any adult acting on behalf of Chabad of S. Johns to seek appropriate medical care and treatments for my child, if necessary. I further agree to pay all charges for that care and/or treatment. It is understood that if time and circumstances reasonably permit, Chabad of S. Johns personnel will try, but are not required, to communicate with me prior to such treatment. I further agree that I will not hold Chabad of S. Johns accountable for the nature and outcome of any emergency medical treatment.I allow my child to be photographed while participating in the Grow activities and these pictures may be used for marketing purposes.I give permission for my child to attend any field trips and outings that may take place during the GROW Enrichment program.
Workshop Selection
*The Aleph Champ Workshop is included in every session.*
Full Grow Enrichment Program $750High Holiday Discovery (3 weeks)Adventure to the Holy Land (4 weeks)Chanukah Studio (4 weeks)JScience II (2 weeks)Mitzvot Mania (4 weeks)Jewish Heroes (4 weeks)Holiday Art Series (5 weeks)
Payment Schedule*
Nobody will be turned away due to lack of funds. For financial assistance or payment plans please call the office at 904.701.4422.

Payment*

Credit Card Check

Postal / Zip Code

Country

Should be Empty:

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In this Section

● Returning Students Registration

Begins September, 04 2018

3:45-5:45

At Durbin Creek Elementary School

Highlights of the year 2015-2016

Upcoming Events

There are no events posted at this time. Please contact us for more info about our events.

GROW After-School Enrichment Program

Parents Information

Workshop Selection