Parent 1 Name* First Name Last Name Phone Number* E-mail* Parent 2 Name First Name Last Name Phone Number E-mail Child's Name* First Name Last Name Current Grade* School Attending* Please read carefully before selecting Registration is available for individual classes ($10/class) or for the entire session. By registering for all 10 classes, you will receive an automatic 50% discount! This registration does not include Wednesdays class, please register separately here The dates are: Tuesdays - January 6, January 13, January 20, January 27, February 3 Thursdays - January 8, January 15, January 22, January 29, February 5 Wednesdays - require separate registration Select this option for ALL classes for 50% off All 10 classes for Tuesdays & Thursdays Tuesdays JewQ Trivia, Jewelry Making Select ONLY if registering for individual dates January 6January 13January 20January 27February 3 Thursdays Challah Club/Kosher Cooking, Filmmaking Select ONLY if registering for individual dates January 8January 15January 22January 29February 5 Total $0.00 Emergency contact other than parents* First Name Last Name Phone number of emergency contact* Who else is authorized to pick up the child* Dinner is served weekly- does your child have any allergies or food restrictions? Yes! I would like to help another child experience this amazing program! $50$100$360 Payment Credit Card No payment required for registered Hebrew School students Credit Card We accept Visa, MasterCard, American Express, Discover Credit Card Number Security Code Name on Card1 - January2 - February3 - March4 - April5 - May6 - June7 - July8 - August9 - September10 - October11 - November12 - December Expiration Month2025202620272028202920302031203220332034 Expiration YearBilling Address Street Address City State / Province Postal / Zip CodePlease SelectUnited StatesAfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanThe BahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChilePeople's Republic of ChinaRepublic of ChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongoCook IslandsCosta RicaCote d'IvoireCroatiaCubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonThe GambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorthern MarianaNorwayOmanPakistanPalauPanamaPapua New GuineaParaguayPeruPhilippinesPitcairn IslandsPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint BarthelemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSomalilandSouth AfricaSouth OssetiaSpainSri LankaSudanSurinameSvalbardSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTristan da CunhaTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamBritish Virgin IslandsUS Virgin IslandsWallis and FutunaWestern SaharaYemenZambiaZimbabweOther Country Policies: Classes must be registered and paid for prior to attendance Children must be picked up precisely on time. consistent late pickups will result in a fee cKids After School promotes respect, kindness, and safety for all participants. Children are expected to listen to staff, use respectful language, and keep hands and objects to themselves. Rough play, bullying, or disrespectful behaviour will not be tolerated. If issues arise, children will receive a reminder, a brief break, and parents may be contacted if behaviour continues. Serious or repeated misconduct may lead to suspension from the program. By submitting this form, I acknowledge that I will be charged for registration and that I agree to the policies outlined above. Submit Should be Empty: This page uses TLS encryption to keep your data secure.
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