Aleph Champ Registration Form

Thank you for your interest in the Aleph Champ Program!

We look forward to a great 6-week session - Nov 3-15, every Thursday, 4:30-6pm.

Ideal and prime ages are 4-11 years old.

Cost is

$72 for one child

$140 for two children

$200 for three or more children

Timely and full attendance makes a big difference to your child's experience.

For any questions please call Goldie at 217-840-4447

For any questions regarding programs for young teens / Bar or Bat Mitzvah lessons, please call Goldie at 217-840-4447
Child's Name*
Child's Hebrew Name
Age*
Grade
Second Child's Name
Second child's Hebrew Name
Second Child's Age and Grade
Third Child's Name
Third Child's Hebrew Name
Third Child's Age and Grade
How familiar is your child with the Hebrew Letters?

little knowledge recognizes some letters recognizes all letters
Would you like your child to additionally learn 'ksav' - handwritten letters?
Will you be able to attend all six weeks?*
E-mail*
Add to mailing list
Phone Number*

- Area Code Phone Number
Comments/Allergies/Information we should know

Payment:

Credit Card

/ Expiration Month Expiration Year

Billing Address

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Country

I'd rather bring a check on Nov 3 in the amount of:

$72 for 1 child $140 for 2 childre $200 for 3 children
*

$72 $140 $200
Should be Empty:

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