Please fill out the form below carefully. When you press submit, this form will be sent to our administration office.

Note: Please use a separate form for each child.

Child Info

Full Name   Hebrew Name
Date of birth   School
Address   Allergies
City/State/Zip       Comments


Parents Info

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


Emergency Info

Contact Name   Phone Number
Relation to child   Child's Doctor


Registration Options

Hebrew Reading Club (12 Week Session – Sundays 11-12pm)* Session Cost: $180 (includes all materials)    
Jewish Art Club (12 Week Session – Sundays 12:15-1:15pm)* Session Cost: $180 (includes all materials)    
Mini Chefs (15 Mondays, 4:15-5:15pm) Session Cost: $180    
   *Receive 15% off when signing up for both Sunday clubs.    


Payment Info

CC Type   Card #:
Exp. Date Total Amount
      Will Send Check


As the parent(s) or legal guardian of the above child, I/we authorize any adult acting on behalf of JAZ-Jewish Arts Club to secure treatment for my/our child, I/we further agree to pay all charges for that care and/or treatment.  It is understood that if time and circumstances reasonably permit, Jewish Arts Club personnel will try, but are not required, to communicate with me/us prior to such treatment.  I/we hereby give permission for my/our child to be photographed while participating in Jewish Arts Club activities which will be posted on the Chabad of Oakland website.

I agree to the terms and conditions above. Please initial here: