GROW Registration

IF ALL YOUR CHILDREN HAVE ATTENDED GROW BEFORE AND THERE IS NO INFORMATION THAT NEEDS UPDATING, PLEASE CLICK HERE FOR THE EXPEDITED FORM
1. Child/ren’s Information
Child 1

Name Hebrew Name Last Name
Birth Date & time (for Hebrew Birthday)

Month Day Year
at Hour Minutes
Gender*

MaleFemale
Child 2

Name Hebrew Name Last Name
Gender

MaleFemale
Birth Date & time (for Hebrew Birthday)

Month Day Year
at Hour Minutes
Child 3

First Name Hebrew Name Last Name
Gender

MaleFemale
Birth Date & time (for Hebrew Birthday)

Month Day Year
at Hour Minutes
2. Parent information
Home Phone Number*

Area Code Phone Number

Address*

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Mother's info

First Name Last Name
Work Phone

Area Code Phone Number
E-mail Primary email
Cell Phone

Area Code Phone Number
Father's info

First Name Last Name
Work Phone

Area Code Phone Number
E-mail
Cell Phone

Area Code Phone Number
How did you hear of GROW?
Is the natural mother of the child Jewish?*

YesNo
Are there any conversions or adoptions in the family? (Including Parents, Grandparents, Great -Grandparents etc..)*

YesNo
If yes, please explain
What goals do you have for your child attending GROW?
3. Emergency Information
Emergency Contact*

First Name Last Name
Phone Number*

Area Code Phone Number
Relationship*
Doctors Name*

First Name Last Name
Doctors Phone Number*

Area Code Phone Number
Does your child(ren) have any allergies or medical conditions.*

If yes please specify which child and what they are.
Permission for emergency medical treatment*

As the parent or legal guardian, I authorize any adult acting on behalf of GROW to hospitalize or secure treatment for my child. I further agree to pay all charges for that care and/or treatment. It is understood that if time and circumstances reasonably permit, Grow personnel will try, but are not required, to communicate with me prior to such treatment.
4. Special Opportunity!

In the Old City of Jerusalem, there’s a special Torah scroll being written for Jewish children. Over two million children have already bought their own letter in these Torah scrolls. You, too, can buy a letter in a Torah scroll and unite with Jewish children from all over the world.
You will receive a beautiful certificate from Israel, the Holy Land, with your name and the name of the Torah portion where your letter has been written!
Yes! I’d like to buy my child their own letter in the Children’s Torah! Cost $1
5. Payment Information
The tuition for GROW is $610.00 per year per child (this does not include $50 registration & book fee). For members it is discounted to $410. Family discounts and scholarships available.

For more information about scholarships or for assistance with a financial plan, please contact Rabbi Pinchas Adler 727 631 7398
Payment Options*

Plan A: I will pay the entire amount in full.To do so, please submit a check or include your credit card information below.Plan B: I will pay the annual tuition on a montl April. All checks musty basis by check. I will send in checks of $76.25 each (Members $51.25), September through n up.be submitted on the first GROW of the month. This is in addition to the registration/book fee of $50 due at sigPlan C: I will pay the annual tuition on a monthly basis by credit card. This is in addition to the registration/book fee of $50 due at sign up. Your card will be billed $76.25 monthly (Members $51.25) September through April. To do so please include your credit card number and expiration date at the bottom of this page. Credit cards will be charged on the first of the month unless otherwise indicated.Payment plan discussed with Rabbi Pinchas

Payment*

Credit Card Check

Agreement*

I am signing up my child for GROW. I give my child permission to attend all trips. I give permission to GROW to photograph and videotape my children and use the photos and videos for advertising purposes.
Please share any other information you feel is important for GROW to be aware of. This can include exceptional behavior, concerns, particular activities, family relationships etc.
NOTE: if this is your child's first year attending GROW we will contact you to set up a brief meeting regarding acceptance. Filling out the registration form does not automatically ensure enrollment for first time students. Thank you!
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1. Child/ren’s Information

2. Parent information

3. Emergency Information

4. Special Opportunity!

5. Payment Information

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