Chaverim Easy Re-Registration Form 2020-2021

Student's First Name
Student's Last Name
Grade in Fall 2020
1st Responsible Parent/Guardian Name
1st Parent/Guardian Email
1st Parent/Guardian Cell Phone
Student Cell Phone

Changes to Contact, Medical or Emergency Information
The contact, emergency and medical information from last year is accurate and there are no changes. If there are changes, please put the current information in the box below.
  yes
 no
Please indicate if there are any changes to contact, emergency or medical information.

Chaverim full annual tuition $450. Please enter the amount you wish to pay today (deposit is necessary to complete registration):

  • $100 deposit - Balance $350 due no later than December 1, 2020
  • $100 deposit and 5 monthly payments of $70 - credit card must be kept on file at the JCC office call (707) 528-4222
  • $450 full tuition - no balance due

 
Amount of Payment (do not use $)
Type of credit card
Name on card
Credit card number
Expiration
CVV

Contact Information Changes? 
Provide new home address and phone information here:
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