Register

Welcome! We are currently accepting application forms for the 2023-2024 JEC year. If you have any questions or concerns you'd like to discuss with us, please contact us at 310-428-5492.

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.

Please note if you wish to pay by cash/check or zelle, please contact Rabbi Sholom at 347-915-3770 and you will receive a different form.
Child's Profile
Child's Name*

First Name Middle Name Last Name
Hebrew Name*
Birth Date*

Month Day Year
Time of Birth or Jewish Birthday*
Gender*

MaleFemale
Grade*
School*
Previous Jewish Education

YesNo
Where?
Hebrew Reading Proficiency

NoneSomewhatWell
CONFIDENTIAL: Does your child have an IEP or other learning or social 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 Information

Address*

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

Parent/Guardian 1*

First Name Last Name
Parent/Guardian 1 Cellphone*

Area Code Phone Number
E-mail* Primary email
Marital Status*

MarriedSingleDivorced/Seperated
Parent/Guardian 2

First Name Last Name
Parent/Guardian 2 Cellphone

Area Code Phone Number
Parent/Guardian 2 E-mail
Is the natural mother and maternal grandmother of the child Jewish?*

YesNo
*Please note: As JEC is as a Bar & Bat Mitzvah preparation program it is bound by the policies of the central Chabad office as well as the Rabbinical policies of Israel (as are all Jewish lifecycle events).

Thereby this specific program is only open to children whose mothers were born Jewish or underwent/ are undergoing an Orthodox conversion.

Please feel welcome to join our wide variety of programs at Chabad geared to all.
Have there been any conversions or adoptions in the family?*

YesNo
Please explain conversion/adoption. If there was a conversion, please upload a copy of the certificate below.
Please upload a copy of the conversion certificate or email it to [email protected].
How did you hear of us?*
Would you like to register a Second Child

YesNo
Child's Name*

First Name Middle Name Last Name
Hebrew Name*
Birth Date*

Month Day Year
Time of Birth or Jewish Birthday*
Gender*

MaleFemale
Grade*
School*
Previous Jewish Education

YesNo
Where?
Hebrew Reading Proficiency

NoneSomewhatWell
CONFIDENTIAL: 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...
Would you like to register a Third Child

YesNo
Child's Name*

First Name Middle Name Last Name
Hebrew Name*
Birth Date*

Month Day Year
Time of Birth or Jewish Birthday*
Gender*

MaleFemale
Grade*
School*
Previous Jewish Education

YesNo
Where?
Hebrew Reading Proficiency

NoneSomewhatWell
CONFIDENTIAL: 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...
Emergency Contact Information
Emergency Contact*

First Name Last Name
Phone Number*

Area Code Phone Number
Relationship*
Pediatrician*

First Name Last Name
Phone Number

Area Code Phone Number
Medical 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*

Yes
Full Name*

First Name Last Name
Date*
We look forward to a wonderful year of fun, learning and growth!
Enrollment
After 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 Comments
Payment
Jewish Enrichment Club - Tuesday Afternoons

One Child Tuition $1,180 (Sept - May)Two Children Tuition $2,242 (Sept - May)Three Children Tuition $3,304 (Sept - May)JEC Trial Class $36
Optional Donation

$180$360$500 Sponsor a Day of Learning$750 Sponsor a JEC Holiday Fun Day$1,180 Sponsor a Child
Total

$0.00

I would like to pay today:Full amount50% minimum: $0.00 $

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

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

Street Address Line 2

City

State / Province

Postal / Zip Code

Country

Yes, I'd like to make this a monthly recurring payment.
Should be Empty:

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Educate Your Child... Educate a Generation

Child's Profile

Family Information

Emergency Contact Information

Enrollment

Payment