JOIN - Tot Shabbat - Chabad of the Space & Treasure Coasts

Address*

Your E-mail (for confirmation)*
Please let us know if there are any allergies or other important information we need to be aware of.
Father's Information
Child's Father*
First Name Last Name
Father's cell
Father's E-mail
Is the child's father Jewish?*
Mother's Information
Child's Mother*
First Name Last Name
Mother's cell*
Mother's E-mail*
Is the child's mother Jewish?*
Please provide more information regarding the parent's conversion
Volunteer

I am willing to assist in school activities, please contact me
Emergency Information
Emergency Contact*
First Name Last Name
Phone Number*
Enrollment options
Tuition (for the complete year):
$1800 for Half day Option 8:30-12:00
$2250 for Full day Option 8:30-2:30 Optional aftercare available. enrollment required.
I am enrolling for:* We will contact you regarding the tuition payment process

Half day 8:30-12:00Full day 8:30-2:30Full day with after care 8:30-4:00
Tuition Payment plan* We will contact you regarding the tuition payment process

Plan A - Pay in full before Aug. 18th (receive a 5% discount)Plan B - 50% Aug. 18th and 50% Jan. 1stPlan C - Ten month payment plan - $180/child/month for half day, $225/child/month for full day - beginning Aug. 18
Tuition agreement*

I have reviewed the tuition rates listed above and agree to pay the amount for my child/ren to attend the Tot Shabbat & Holiday Enrichment Program
Registration Fee*
Total due now (registration fee)

$0.00

Payment

Credit Card

We accept Visa, MasterCard, American Express, Discover
Credit Card Number	Security Code
Name on Card
Expiration Month	Expiration Year

Billing Address

Street Address

City

State / Province

Postal / Zip Code

Country

Terms of Enrollment (Check box)*

As the parent(s) or legal guardian of the above child(ren), I/we authorize any adult acting on behalf of Torah Academy to hospitalize or secure treatment for my child, I further agree to pay all charges for that care and/or treatment. It is understood that if time and circumstances reasonably permit, Torah Academy personnel will try, but are not required, to communicate with me prior to such treatment. I hereby give permission for my child to participate in all school activities, and allow my child to be photographed while participating in the program and that these pictures may be used for marketing purposes.
How did you hear about us
We look forward to a wonderful year of learning and growth!
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Student Information