Welcome! We are currently accepting application forms for the 2022-2023 JEC year. If you have any questions or concerns you'd like to discuss with us, please contact us at 310-428-5492.Please note that one registration form per child is needed.We look forward to a wonderful year of learning and growth.Click here for JEC Dates & Rates.If your child attended our JEC program last year, please click here to fill a returning student form. Child's ProfileChild's Name*First NameMiddle NameLast NameHebrew Name*Birth Date*1 - January2 - February3 - March4 - April5 - May6 - June7 - July8 - August9 - September10 - October11 - November12 - DecemberMonth12345678910111213141516171819202122232425262728293031Day2022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920YearTime of Birth or Jewish Birthday*Gender*MaleFemaleGrade*School*Previous Jewish EducationYesNoWhere?Hebrew Reading ProficiencyNoneSomewhatWellCONFIDENTIAL: Does your child have an IEP or other learning challenges? If yes, please describe them and indicate special precautions or care needed.What are your goals in terms of your child's experience at Jewish Enrichment Club? Please number each line with numbers 1 to 5. (1=top priority), and add your own to the list. (0=not a priority) Thank you!Jewish Identity Being in a Jewish environment Hebrew reading Hebrew Language Socializing with Jewish friends Jewish History Knowledge of holidays and traditions Knowledge of Jewish practices/mitzvot Knowledge of basic Jewish prayers Add your own...Family InformationAddress*Street AddressStreet Address Line 2CityState / ProvincePostal / Zip CodePlease SelectUnited StatesAfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanThe BahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChilePeople's Republic of ChinaRepublic of ChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongoCook IslandsCosta RicaCote d'IvoireCroatiaCubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonThe GambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorthern MarianaNorwayOmanPakistanPalauPanamaPapua New GuineaParaguayPeruPhilippinesPitcairn IslandsPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint BarthelemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSomalilandSouth AfricaSouth OssetiaSpainSri LankaSudanSurinameSvalbardSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTristan da CunhaTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamBritish Virgin IslandsUS Virgin IslandsWallis and FutunaWestern SaharaYemenZambiaZimbabweOtherCountryParent/Guardian 1*First NameLast NameParent/Guardian 1 Cellphone*Area CodePhone NumberE-mail*Primary emailMarital Status*MarriedSingleDivorced/SeperatedParent/Guardian 2First NameLast NameParent/Guardian 2 CellphoneArea CodePhone NumberParent/Guardian 2 E-mailIs the natural mother and maternal grandmother of the child Jewish?*YesNoHave there been any conversions or adoptions in the family?*YesNoPlease explain conversion/adoption. If there was a conversion, please send a copy of the certificate to [email protected]Please send a copy of the conversion certificate to [email protected]How did you hear of us?*EmailFacebookInternet SearchAttended PreviouslyFriendOtherEmergency Contact InformationEmergency Contact*First NameLast NamePhone Number*Area CodePhone NumberRelationship*Pediatrician*First NameLast NamePhone NumberArea CodePhone NumberMedical Insurance*Policy #*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.*List all persons authorized to pick-up child from school.As the parent(s) or legal guardian of the above child, I/we authorize any adult acting on behalf of the Palisades Jewish Enrichment Club/Chabad 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, the Palisades Jewish Enrichment Club/Chabad 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, join in class and school trips on and beyond school properties and allow my child to be photographed while participating in the Palisades Jewish Enrichment Club/Chabad activities and that these pictures may be used for marketing purposes.I Accept*YesFull Name*First NameLast NameDate*Jewish Enrichment Club - Tuesdays 3:00-4:45pmJEC 2022-23 Tuition $1,000JEC Trial Class $25We look forward to a wonderful year of fun, learning and growth!Please select your choice below:EnrollmentAfter you have successfully submitted your application it will be subject to review. We will reach out to schedule a follow up call to discuss your application and confirm it's approval. Once approved a link will be sent to submit tuition to complete your child's enrollment. General CommentsSubmitShould be Empty: This page uses TLS encryption to keep your data secure.