Returning Students Registration - Chabad St. Johns County

If any of your info (address, medical etc.) has changed please note in the comment section below or fill out the complete new student registration form.
Child's Name*
First NameLast Name
School
Grade entering
Parent Email (for confirmation)*
Comments:
Payment Info
Full Grow Enrichment Program $800
Location:*
St. JohnsNocatee
Payment Schedule*
Non-refundable registration fee:
$0.00

Payment

Credit Card

Billing Address

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Country

Please charge my balance:*
Via CC above.
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.
Signature*
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