Jew Crew (Post-b’nai mitzvah)

Thank you for registering your teen in Jew Crew. We look forward to seeing them in the fall.

Please do not hesitate to contact our treasurer at treasurer@uvjc.org for special abatements or scholarships if you are in financial need. The UVJC does not turn anyone away for financial reasons.

Name*

First Last Hebrew

Date of birth*

Gender*

Teen's email*

Teen's cell phone

Education information*

Please describe your teen's learning style and provide any tips you have to help the teacher succeed in working with them.

Physician's Name*

Physician's Phone Number*

Allergies/Special Health Considerations*

Medication authorization

I authorize the UVJC to administer medications that I have supplied for medical conditions noted above. I have supplied the following medications to the Director of Education, and instructions are attached to the medications supplied.

Photo authorization

Please indicate below whether you give permission for your teen’s first name(s) and/or photograph(s) or video(s) to be used on the UVJC website, in school newsletters, in congregational newsletters, and on weekly email updates.

Mitzvah opportunities*

Please check the mitzvot you would like to undertake this year:

Tuition*

Parent/Guardian 1 Information

Name*

First Last

Address*

Street Address Address Line 2 City State ZIP Code

Phone (primary)*

Phone (secondary)*

Email*

Parent/Guardian 2 Information

Name*

First Last

Address*

Street Address Address Line 2 City State ZIP Code

Phone (primary)*

Phone (secondary)*

Email*

Health insurance company*

Insurance policy number*

Insurance company contact information*

Alternative Emergency Contact (Primary)

Name*

First Last

Address*

City State

Phone (primary)*

Phone (secondary)*

Payment Information

You will be sent an invoice via email. Please direct any questions to Chris DePierro by email at office@uvjc.org or by phone at (603) 646-0460.

Total

$0.00

Upper Valley
Jewish Community

Jew Crew (Post-b’nai mitzvah)