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Register Online

Register Online

Please fill out this form as an initial registration for the CJC Hebrew School. To register and pay via check please send to our office 4010 Park Street North • St. Petersburg, FL 33709-4034
Student Information
Male Female
Does your child have previous Jewish Education Yes No
If yes, please describe:
What school does your child attend? Grade entering:
Synagogue affiliated with:
Is the natural mother of the child Jewish? Yes No
Were there any conversions or adoptions in your family? Yes No
If yes, please describe:
Does your child read basic Hebrew? None Somewhat Well
Does your chld have any difficulty with general studies?
Parent Information
Emergency Contact Information
Please list two contacts to be used in case of emergencies (other than your home and business numbers).
Accept Do Not Accept
Card Information
Card Number
Expiration
CVV Security Code
Name on Card

Charge Amount


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