Register!

Please fill out ALL required fields of this form. If you have any questions or concerns you'd like to discuss with us, please call Levi at 704 729 4232 or email [email protected]

We look forward to a wonderful year of learning and growth!

If you are interested in learning more about our program, click here to leave us your information, and we'll reach out to you!

Full Name*

First Name Last Name

Hebrew name*

Date of Birth*

Month Day Year

School*

Grade*

Select grade

If Someone Referred You to CKids Tell Us Who :)

Would you like to register a second child?* Get $100 off your second child!

YESNO

Full Name*

First Name Last Name

Hebrew name*

Date of Birth*

Month Day Year

School*

Grade*

Select grade

Full Name*

First Name Last Name

Cell*

Area Code Phone Number

Email*

Full Name

First Name Last Name

Cell

Area Code Phone Number

E-mail

Home Number

Area Code Phone Number

Address*

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

Parents Marital Status*

MarriedDivorced/ Separated

Mom is:*

Dad is:*

Are there adoptions in the family? If yes, Please elaborate

Please let us know; With whom does the child(ren) reside? To whom shall school correspondence be sent?

Do your child/children have any previous Jewish Education?

YesNo

Emergency Contact #1*

First Name Last Name

Phone (Contact #1)*

Area Code Phone Number

Emergency Contact #2

First Name Last Name

Phone (Contact #2)

Area Code Phone Number

1. Is your child/children allergic to any foods? If yes, please explain in detail

2. Is there any special medical or any other information regarding your child/children that our school should be aware of?

CKids Registration Annual fee for one child

$600

CKids Registration Annual fee for 2 children, including a 100 dollar discount!

$1100

Total

$0.00

Yes, I'd like to donate the cost of processing this transaction by adding 3%

Payment*

Credit Card Other: Check, payment plan, etc.

Postal / Zip Code

Country

Notes

As the parent(s) or legal guardian(s) of child/ren noted above, I/we authorize any adult acting on behalf of CKids 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, the staff will try to communicate with me prior to such treatment.

I/we hereby give permission for my child/ren to attend all field trips and outings organized by CKids. I/we hereby give permission for my child/ren to be transported by CKids on field trips.

I/we allow my child/ren to be photographed while participating during school activities. I/we understand that these photographs may be used for publicity purposes.

I accept the terms above.*

Accept

Guardian Digital Signiture*

First Name Last Name

CKids Registration

Child's Information

Child 2's Information

Family & Contact Information

Parent 1

Parent 2

Household

Emergency / Medical information

Terms