Club Judea Registration 2024-2025 Session 2

* Parent 1 - First Name

* Parent 1 - Last Name

* Parent 1 - Email

* Parent 1 - Cell Phone

* Home Address

* Home City

* Home State

* Home ZIP

Home Phone Number

* Religious Affiliation

Employer

Occupation

Work Phone Number

* Marital Status

Parent 2 - First Name

Parent 2 - Last Name

Parent 2 - Email

Parent 2 - Cell Phone

Employer

Occupation

Work Phone Number

* Religious Affiliation

Please select who is the primary point of communication for your family:

Does parent 2 live at the same address?

Home Address

Home City

Home State

Home ZIP

Home Phone Number

Click on the + button to add each child

* Child's First Name

* Child's Last Name

Child's Nickname

* Child's Date of Birth

Child's Gender

* Child's Age as of Sept 1, 2024

What school does the student attend during the weekday:

* Which Temple Judea school program does the child particpate in:

(There is a $150.00 registration fee for all new students who don't currently attend Club Judea)

* Please choose the number of days you will be attending Club Judea each week:

* What strategies does your child use to learn new material?

* Is there anything else we should know to support your child's experience?

* Does your child have any special needs that may effect his/her education?

* Please list any allergies your child has including pets, food, medications or circumstances of which we should be aware:

Click the + sign below to add another child

I hereby grant permission for the Club Judea at Temple Judea to utilize artwork, photographs or any other visual representation of my son/daughter in connection with any Temple Judea brochure, video, promotion, website, advertising or any other media. Names and personal information of the children will not be disclosed.

I hereby grant permission for the faculty and staff of Club Judea at Temple Judea to share pictures of my child through a private classroom website and/or application.

Mandatory Financial Payment Information As part of our registration process, it is required that you agree to keep a credit card on file. You will be held responsible for tuition for the school year unless written notice of cancelation is received before January 1st. Charges will not be refunded or prorated if the child is absent or otherwise fails to attend after Club Judea opens. Tuition payments are due in full for the session by January 1. Club Judea reserves the right to disallow a child to attend school until their financial obligation is brought current. We also reserve the right to refuse registration for additional programs offered to those whose accounts are not in good standing.

Tuition Payment If payment is not received by the scheduled payment due date, a charge will be processed on your credit card on the 25th of the month. This will process automatically without additional notification.

All Other Outstanding Payments If your account has an outstanding balance that is 30 days past due, a charge will be processed on your credit card on the 25th of the next month. This will process automatically without additional notification.

Cancelation Policy Registration and tuition are non-refundable.

Health Forms No child will be admitted to Club Judea without an updated health form from the child's physician. Forms 3040/680 must be provided to the office by January 1, 2024. These forms are available from your pediatrician's office.

* By checking this box I acknowledge that I have read these policies and will adhere to its terms.

By checking this box I acknowledge that I have read these policies and will adhere to its terms.

Total Tuition and Fees

Once the form is submitted, you will receive an email confirmation with a link to select enrichments.

Wed, April 30 2025 2 Iyar 5785

Temple Judea Gables

5500 Granada Blvd. Coral Gables, FL 33146 | 305-667-5657

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