Student Info

Full Name Date of Birth
Address City / State / Zip
School Allergies
Parents Info

Father's Full Name Mother's Full Name
Father's Cell Mother's Cell
Father's Email Mother's Email
Registration Options

Vail’Hebrew Reading Club 10 incredible workshops- Membership - $55
Yeladim Club 9 Incredible workshops - Membership - $75
Payment Info

Card Type Card Number:
Expiration Date CVV
Please consider an added donation to our scholarship fund
Total Amount