Chaverim Easy Re-Registration Form 2021-2022

Student's First Name
Student's Last Name
Grade in Fall 2021
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.
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, 2021
  • $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

Contact Information Changes? 

Provide new home address and phone information here: