Register Online Student Profile- New and returning students, please fill out. Last Name First Name Hebrew Name Age DOB Month Jan. Feb. Mar. Apr. May Jun. Jul. Aug. Sept. Oct. Nov. Nov. Dec. Date 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Year 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022 Time of Birth - In Judaism the day begins at nightfall, so in order to determine the exact date of your Jewish birthday we need to know what time of day you were born. School Grade Entering Grade Entering Pre-K (4 years old) Kindergarten First Second Third Fourth Fifth Sixth Grade Entering Is the student's mother Jewish? Yes No Converted Is the student's father Jewish? Yes No Converted Hebrew Reading Proficiency None Somewhat Well Previous Jewish Education Yes No Where? Does your child have an IEP and/or any learning disabilities? Please specify (This information will help us better cater to the needs of your child.) Parent Information - New Students ONLY, please fill out. Father's Name Home Phone Father's Cell Father's Email Mother's Name Home Phone Mother's Cell Mother's Email Address City/Zip Email Address you would like a copy of the form emailed to: Emergency Information- New and returning students please fill out. Emergency Contact Home Phone Work Phone Cell Phone Doctor's Name Doctor's Phone Number CONFIDENTIAL: Does your child have any allergies or other medical condition we should be aware of? If yes, please describe them and indicate special precautions or care needed. Registration Payment Agreement No synagogue membership is necessary to attend JUDA Club. Grades Pre-K - 7th: Tuition for a full year of JUDA (September, 2025- May 2026) is $600.00. For members, we offer an additional 10% off. REFER A FRIEND AND RECEIVE $100 OFF Please choose one of the following payment plans. If you would like to spread out your payments, or need other confidential scholarships or financial arrangements, please be in touch with Zalman Groner. No child will be turned down from JUDA due to lack of funds. Rabbi Zalman can be reached at zalman@jewishlouisiana.com or 704-648-7966. Tuiton Plans: Pay in full before year starts Pay in two installments: first with registration, second in November 2025 Pay in three installments: first with registration, second in November 2025, 3rd in February 2026 As per our discussion, the following payment plan will be put in place: Method of Payment Check Credit Card Cash CC Type Please Select Visa Mastercard Amex Card Number Billing Address City, State, Zip CVV Exp Date Total Registration Cost: Parent Involvement Please indicate whether you would be willing to be involved in one or more of the following volunteer activities: Volunteering for our Aleph Champ Hebrew Reading program. If yes, how often? Please let us know about other volunteer activities. This page uses 128 bit SSL encryption to keep your data secure.