Youth Programs Registration 2025/26 Non-Member - Form

Family Account Information

* First name

* Last name

* Email Address

* Home Address

* City

* State

* Zip Code

Student Enrollment Information

* How many students are you registering?

Student 1 Information

* First Name

* Last Name

* Birthdate

* What grade level are you registering this student in?

Early Education | Tot Shabbat Enrollment

Early Education | Tot Shabbat Quarter Selection

Fall 2025Winter 2026Spring 2026

* Youth Programs | Grade 2-4 Enrollment

* Youth Programs | Grade 2-4 Course Selection

* B'nai Mitzvah Labs | Grade 5-7 Enrollment

Student 2 Information

* First Name

* Last Name

* Birthdate

* What grade level are you registering this student in?

Early Education | Tot Shabbat Enrollment

Early Education | Tot Shabbat Quarter Selection

Fall 2025Winter 2026Spring 2026

* Youth Programs | Grade 2-4 Enrollment

* Youth Programs | Grade 2-4 Course Selection

* B'nai Mitzvah Labs | Grade 5-7 Enrollment

Student 3 Information

* First Name

* Last Name

* Birthdate

* What grade level are you registering this student in?

Early Education | Tot Shabbat Enrollment

Early Education | Tot Shabbat Quarter Selection

Fall 2025Winter 2026Spring 2026

* Youth Programs | Grade 2-4 Enrollment

* Youth Programs | Grade 2-4 Course Selection

* B'nai Mitzvah Labs | Grade 5-7 Enrollment

Student 4 Information

* First Name

* Last Name

* Birthdate

* What grade level are you registering this student in?

Early Education | Tot Shabbat Enrollment

Early Education | Tot Shabbat Quarter Selection

Fall 2025Winter 2026Spring 2026

* Youth Programs | Grade 2-4 Enrollment

* Youth Programs | Grade 2-4 Course Selection

* B'nai Mitzvah Labs | Grade 5-7 Enrollment

Adult Emergency Contact

* Emergency Contact Name

* Emergency Contact Phone

Total Tuition Fees