Register New Student

GROW Registration 2021-2022

REGISTER HERE
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 (parents, grandparents, etc)?*
YesNo
If yes, please specify who converted?
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.
Full program registration:
Full Grow Enrichment Program $800
Full Grow Enrichment Program $800
Location*
St. JohnsNocatee
If your child is not able to join for the complete program, choose your sessions here.
High Holiday DiscoveryAdventure to the Holy LandChanukah StudioJScience IIMitzvot ManiaJewish HeroesHoliday Art Series
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.
Non-refundable registration fee:
$0.00

Payment*

Credit Card

Credit Card Type
Credit Card Number	Security Code
Name on Card
Expiration Month	Expiration Year

Billing Address

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Country

Please charge my balance:*
Via CC above.
Should be Empty:

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Parents Information

Full Grow Enrichment Program $800

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