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ב"ה

COB Talmud Torah Registration

1. Child's Name*
First Name Last Name
Hebrew Name
Birth Date*

Month Day Year
Gender*
Current School
Can Your Child Participate In Physical Activities?
Does Your Child Currently Recieve Any of the Following services?

OTPTBT
Allergies/ Medical Condition
Does Your Child Read Hebrew?
Any Pertinent Information Regarding Your Child We Should Know About?
Is the natural mother & maternal grandmother of the child Jewish?
Have there been any conversions or adoptions in the family?
Registration Fee

$50
Doctors Name*
First Name Last Name
Doctor Phone*

Area Code Phone Number
2. Child's Name
First Name Last Name
Hebrew Name
Birth Date

Month Day Year
Gender
Current School
Can Your Child Participate In Physical Activity?
Does Your Child Currenttly Recieve Any of the Following services?

OTPTBT
Allergies/ Medical Conditions
Does Your Child Read Hebrew?
Any Pertinent Information Reguarding Your Child We Should Know?
Marital Status of Parents: Married/ Single/ Divorced/Separated
COB Talmud Torah Fees

1st Child: $14002nd Child: $1250Registration & Book Fee: $50 Per Child
Doctors Name
First Name Last Name
Doctor Phone

Area Code Phone Number
Mothers information*
First Name Last Name
Home Phone*

Area Code Phone Number
Mobile Phone*

Area Code Phone Number
E-mail*
Fathers information*
First Name Last Name
Home Phone*

Area Code Phone Number
Mobile Phone*

Area Code Phone Number
E-mail*

Address*

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

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

Total

$0.00
I would like to receive news and updates by email
*

I/We understand that Chabad of Brentwood reserves the right to refuse admission to any child at any time in the event that tuition is not paid as agreed. I/We give permission for my/our child’s photo to be used for advertising purposes by Chabad of Brentwood and Chabad of California.  I/we authorize any adult acting on behalf of the Chabad of Brentwood to hospitalize or secure treatment for my child. I further agree to pay for all charges for that care and/or treatment. It is understood that, if time and circumstances reasonably permit, Chabad of Brentwood will try to communicate with me prior to such treatment.
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Updates

Registration for 2016-2017 is now open!

First Day of BJA is September 18th

New for this year!

Sunday Mornings

9:30 AM- 12:00 PM