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Kivun After School Registration

Address*

Additional notable InformationPlease let us know if there are any allergies or other important information we need to be aware of.
Parents Information
Father's Name*
First NameLast Name
Father's Cell*
Area CodePhone Number
Father's E-mail
Mother's Name*
First NameLast Name
Mother's Hebrew Name
Mother Jewish by:*
BirthChoice - must be Orthodox conversion (Please provide Certificate of Conversion)
Mother's Cell*
Area CodePhone Number
Mother's E-mail
Best way to send Kivun after school updates:*
Cell PhoneEmail
I am willing to assist in school activities, please contact me
Tuition*
*Tuition is for January - June 2020*
$700 per child for 2x a week$400 per child 1x a week
2x a week Payment Plan*
$100 today - Please charge my card $100 monthly$100 today - I would like to pay in 2 installments - $300 each$700 - I am Paying in full todayI am sending my Child 1x a week
1x a week Payment Plan*
$100 today - Please charge my card $50 monthly$100 - today - I would like to pay in 2 installments - $150 each$400 - I am paying in full todayI am sending my child 2x a week

Payment

Credit Card

Billing Address

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Country

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