Register Online - New Students

Child's Name*

First NameLast Name

Hebrew Name*

Birth Date*

MonthDayYear

Grade entering - September*

Child's Name

First NameLast Name

Hebrew Name

Birth Date

MonthDayYear

Grade entering - September

Child's Name

First NameLast Name

Hebrew Name

Birth Date

MonthDayYear

Grade entering - September

Any there any conversions or adoptions in the family, (please provide details)

Any considerations, such as learning disorder or difficulty, the teacher should be aware of? (Confidential)

Does your child have any allergies or other medical conditions we should be aware of? If yes, please describe them and indicate special precautions or care needed.

What are your child’s special interests, likes or dislikes?

How does your child learn best?

My child will be joining the enrichment class on Sunday mornings 10:30 AM -12:00 PM

Emergency Contact

First NameLast Name

Cell Phone

Area CodePhone Number

Mother's Name

First NameLast Name

Hebrew Name

Mother's Birth Date

MonthDayYear

Mother's Occupation

Address*

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

Phone Number*

Area CodePhone Number

Mother's E-mail*

Mother's Cell*

Area CodePhone Number

Mother's Work Number

Area CodePhone Number

Father's Name*

First NameLast Name

Hebrew Name

Father's Birth Date

MonthDayYear

Father's Occupation

Address (if different)

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

Phone Number (if different)

Area CodePhone Number

Father's E-mail*

Father Cell*

Area CodePhone Number

Father's Work Number

Area CodePhone Number

Marital status:

MarriedDivorcedSingleWidowed

Additional notable Information

Tuesdays or Wednesdays 4:00-5:45 PM
Grades K-4 attend on Tuesdays | Grades 5-7 attend on Wednesdays

$1,375 – when FULL PAYMENT is received by April 7.
$1,425 – when payment received after April 7 or if payments are received in installments.

Hebrew School + Sunday enrichment class
$1,775

Please check off one of the tuition options:

1 Installment of $1375 (before April 7) or $1,425 (after April 7)2 installments; one in April for $775, and another on December 1, 2018 for $650.I need a more flexible payment plan. I understand that my application will not be processed until a plan is in place.My family requests a scholarship. Please contact Sara to discuss.

Total Amount

$

Payment

Credit Card Check

Postal / Zip Code

Country

Register Online - New Students

HEBREW SCHOOL REGISTRATION FOR NEW STUDENTS

Child 1

Child 2

Child 3

Additional Information

Parent's Information

Tuition (includes $75 security fee, books and supplies)

Payment

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