FJC Religious School Registration Form

FEES ASSOCIATED:  First Child $375

2013-2014

                          Additional children $325
fees must be paid prior to August 1, 2013
Mother’s Name:   Father’s Name:
  
Mother’s Cell:    Father’s Cell: 
  
Home Phone:  Home Phone: 
  
E-mail:   E-mail:  
  
Address:   Address:
  
  
Student #1 Name: Age:
  
Date of Birth:Gender:  M   F      
  
Name of Secular School: Grade: 
  
# Years of Religious School Instruction:  Hebrew Name:
  
Allergies:   Medications:
  
  
Student #2 Name: Age:
  
Date of Birth:Gender:  M   F      
  
Name of Secular School: Grade: 
  
# Years of Religious School Instruction:  Hebrew Name:
  
Allergies:   Medications:
  
For additional children, please include above information on back of page. 
  
  

Before sending in this form, please describe any physical restrictions or learning issues we should know about on the back of this form.


We look forward to having you join our religious school family.  Please fill out the form below and mail it along with your payment to:

FJC Religious School 

PO Box 3162

Warrenton, VA  20188