School Registration — Fauquier Jewish Congregation

FJC Learning Intiative Registration 2023-2024

FEES First Child $350 • Each Additional Child $200, Teen Program $150

Please make checks payable to:
Fauquier Jewish Congregation
PO Box 3162
Warrenton, VA 20188

Student Name

First Name

Last Name

Date of Birth

YYYY

Gender

Name of Secular School

Grade

Years of Religious School Instruction

Hebrew Name

Allergies

Medications

Any learning disabilities or challenges?

Second Student Name

First Name

Last Name

Date of Birth

YYYY

Gender

Name of Secular School

Grade

Years of Religious School Instruction

Hebrew Name

Allergies

Medication

Any learning disabilities or challenges?

Mother's Name

First Name

Last Name

Father's Name

First Name

Last Name

Cell

(###)

###

####

Home

(###)

###

####

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

FJC Learning Intiative Registration 2023-2024

P.O. Box 3162
Warrenton, VA 20188

(540) 341-1844
email