Registration

We are currently accepting application forms for upcoming KIDS IN THE KITCHEN session, February 18, 25, March 4, 11, 18, 25 . 4:30- 5:30 p.m.

Please fill out ALL fields of this form. If you have any questions or concerns you'd like to discuss with us, please contact us at 561-659-3884.

STUDENT INFORMATION
First Name
Last Name
Hebrew Name
Don't have one? We can help!
D.O.B.
Jewish Education Current / Previous Yes No
If yes, where?
Siblings names & ages
i.e. Daniel 7, Abigail 4, Jonathan 1
Is there any information concerning your child that is important for the directors of KIK to know?
Does your child have asthma, food allergies or any other medical condition? Yes No
Do you give permission to use photographs of your child in print materials,
on our website and emails? Yes No
All information submitted is strictly confidential and never shared with anyone and is only seen by the teachers of the said program.

PARENT INFORMATION
Father's Name Father's Email
Mother's Name Mother's Email
Address City, State, Zip
Home Phone Mother's Cell

SESSION REGISTRATION


KIDS IN THE KITCHEN: February 18, 25, March 4, 11, 18, 25 | $90

I would love to sponsor a session ($90) for another child!


PAYMENT
First Name
Last Name
Charge Amount
Card Type
Card Number
Exp. Date
CVV Code 3 digits on back of card
I prefer to send a check and will mail it to you.