JewQ Registration

Thank you for considering signing up your child for JewQ, a wonderful program that offers engaging and enriching Jewish education. We look forward to welcoming them into our JewQ program!
Please fill out the form below.
How many children are you registering?* $150 per child including materials, a textbook, and prizes for the tests (Scholarships Available)
There will be a separate fee for the children that will qualify for the Shabbaton.
Child's Information
Child's Name*

First Name Last Name
Birth Date*

Month Day Year
Gender*

MaleFemale
Please check all that are appropriate*

Child was born to a Jewish motherThere are conversions to Judaism in the child's maternal familyChild is not Jewish but interested in attending JewQChild is adopted in to a Jewish family
School Information
Name of School*
Grade Entering in September 2024*
Is your child enrolled in a Hebrew School?*

YesNoNo, but I am interested in finding out more information about the CKids Jewish Enrichment Club
Parent/Guardian Information
Parent/Guardian*

First Name Last Name
Phone Number*
E-mail*
I would like to receive news and updates from Chabad-Lubavitch of Nebraska by email. I understand that information I provide to Chabad-Lubavitch of Nebraska will be used according to its Privacy Policy and I can unsubscribe at any time.

Address*

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

How did you hear about us?

MailerEmailFacebookInternet SearchAttended previouslyFriend
Child's Information (2)
Child's Name (2)

First Name Last Name
Birth Date (2)

Month Day Year
Gender (2)

MaleFemale
Please check all that are appropriate (2)

Child was born to a Jewish motherThere are conversions to Judaism in the child's maternal familChild is not Jewish but interested in attending Gan IzzyChild is adopted in to a Jewish family
School Information (2)
Name of School (2)
Grade Entering in September 2024 (2)
Is your child enrolled in a Hebrew School? (2)

YesNoNo, but I am interested in finding out more information about the CKids Jewish Enrichment Club
Child's Information (3)
Child's Name (3)

First Name Last Name
Birth Date (3)

Month Day Year
Gender (3)

MaleFemale
Please check all that are appropriate (3)

Child was born to a Jewish motherThere are conversions to Judaism in the child's maternal familChild is not Jewish but interested in attending Gan IzzyChild is adopted in to a Jewish family
School Information (3)
Name of School (3)
Grade Entering in September 2024 (3)
Is your child enrolled in a Hebrew School? (3)

YesNoNo, but I am interested in finding out more information about the CKids Jewish Enrichment Club
Child's Information (4)
Child's Name (4)

First Name Last Name
Birth Date (4)

Month Day Year
Gender (4)

MaleFemale
Please check all that are appropriate (4)

Child was born to a Jewish motherThere are conversions to Judaism in the child's maternal familChild is not Jewish but interested in attending Gan IzzyChild is adopted in to a Jewish family
School Information (4)
Name of School (4)
Grade Entering in September 2024 (4)
Is your child enrolled in a Hebrew School? (4)

YesNoNo, but I am interested in finding out more information about the CKids Jewish Enrichment Club
Is there a friend you'd like to invite to join you?
I'd like to donate and help other children benefit from this program.
Donation Amount

$
Payment
Total

$0.00

I would like to pay today:Full amount$50.00 minimum$
*If you choose to pay the minimum amount of $50 per child, the remaining amount will be subsidized. Please use the "Other" amount field if you are registering for more than one child with subsidy.

Payment

Credit Card Paypal Check or Cash

Postal / Zip Code

Country

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JewQ Registration

Thank you for considering signing up your child for JewQ, a wonderful program that offers engaging and enriching Jewish education. We look forward to welcoming them into our JewQ program!

Child's Information

School Information

Parent/Guardian Information

Child's Information (2)

School Information (2)

Child's Information (3)

School Information (3)

Child's Information (4)

School Information (4)

Payment

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