Registration

Part 1: Basic Contact Information

Student's Basic Information:

Name(Required)

First Last

Home Address(Required)

Check here if same as parent

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Email(Required)

Cell Phone

Grade(Required)

School(Required)

Gender(Required)

Allergies(Required)

Pertinent Medical History(Required)

School Clubs/Teams(Required)

Include any school clubs or teams and the semester you participated (fall, winter, spring).

Part 1: Basic Contact Information

Parent/Guardian's Basic Information:

Mother's Name(Required)

First Last

Mother's Email(Required)

Mother's Phone(Required)

Is Mom Jewish?(Required)

Father's Name(Required)

First Last

Father's Email(Required)

Father's Phone(Required)

Is Dad Jewish?

Parent's Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Marriage Status(Required)

Names of Siblings & Ages(Required)

Ex. Harry - 11 Years Old

Part 3: For Parents to Answer

What would you like your son/daughter to get out of Kulanu (in addition to the learning)?(Required)

What specific topics would you like your son/daughter to learn at Kulanu?(Required)

Is there anything that we should know about your son/daughter that can help us service and teach him/her best?(Required)

Username(Required)

Create a username for accessing online materials.

Password(Required)

Enter Password Confirm Password

Kulanu Registration Fee

*Scholarships available upon request. No student will be turned away due to financial need. If unable to pay tuition please contact us at info@Kulanu613.org

Price:

Payment Method*

American Express

Discover

MasterCard

Visa

Card Number Expiration Date Security Code Cardholder Name

CAPTCHA

Part 1: Basic Contact Information

Part 1: Basic Contact Information

Part 2: For Students to Answer

Part 3: For Parents to Answer