(949) 644-1999 | (949) 706-0644

1011 Camelback Street Newport Beach CA 92660 US

Student 2 Name:

Special Needs - Educational or Medical

Emergency Contact and phone number *

Parent/Guardian Cell Phone *

Contact home address *

Parents Names: *

I authorize TBY and JCAL to use photos/videos, and /or other likenesses of my child for any promotional materials regarding school and youth programs. Promotional materials bearing these likenesses may be distributed for free to the public and posted on the TBY website and social media outlets. TBY reserves the right to use any photo/video or likeness for a time period beginning when this form is submitted and ending upon written request of participant, parent or legal guardian. *

Yes

JCAL Payment Options *

Please have someone contact me regarding payment

I will mail or drop off a check on or prior to September 17, 2017

Please bill my credit card number listed. Indicate if 1 payment (September) or 2 payments (September and October). Will default to 1 payment if not specified.

Student 3 Grade Level

Contact email address(s) - please separate with a comma

Student 3 Name:

Credit card number, expiration and CVV from back of card. Let us know also if 1 or 2 payments*. All credit cards will incur a 3.5% handling fee

Student 1 Grade Level *

(All grades must complete this question) Optional PreK-2nd Grade Enrichment 11:15 am - 12:30 pm: $250 + JCAL fee *

Yes

Parents Names:

Sunday Schedule

9:00-11:15 am...PreK-2nd JCAL Classes and 7th Grade Discovery class

9:00-10:45 am...Hebrew (3rd-6th Grades)

10:45am- 12:30pm... JCAL Judaic Studies (3rd - 6th Grades)

11:15am -12:30 pm...PreK-2nd Enrichment option for those with older siblings in Sunday JCAL ($250 extra)

(* Required Fields)

Student 1 Name: *

Student 2 Grade Level

2017 Fees

PreK - 2nd grade: $650
3rd - 6th grade : $975
7th Grade Discovery Class and Hebrew on Thursday: $975
TVT B'nei Mitzvah Discovery Class(Sunday only): $750

(949) 644-1999 | (949) 706-0644

2017 Fees

Student #3

Student #2

Student #1

JCAL REgistraTion