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Family Information
Family Name      
Address City
Zip Code Home Phone
Father's Name Hebrew name (if available)
Father's Email Father's Cell Phone
Mother's Name Hebrew name (if available)
Mother's Email Mother's Cell Phone
Marital Status of Parents Any conversions in the family?
Is the father Jewish? Is the mother Jewish?
       
Child Information
1. Child's Name

Hebrew Name
DOB Hebrew DOB (if not known, please indicate time of birth)
School Attending Grade Entering
Is the child adopted? List regular medications
Allergies to food or meds? Need for an Epi-pen?
       
2. Child's Name Hebrew Name
DOB Hebrew DOB (if not known, please indicate time of birth)
School Attending Grade Entering
Is the child adopted? List regular medications
Allergies to food or meds?   Need for Epi-pen?  
       
3. Child's Name Hebrew Name
DOB Hebrew DOB (if not known, please indicate time of birth)
School Attending Grade Entering
Is the child adopted? List regular medications
Allergies to food or meds?  Need for Epi-pen?




4. Child's Name Hebrew Name
DOB Hebrew DOB (if not known, please indicate time of birth)
School Attending Grade Entering
Is the child adopted? List regular medications  
Allergies to food or med?
Need for Epi-pen?
Please name/age siblings who are not being enrolled in the Hebrew School for the year 2018-2019
Please list name(s) of those (other than parents) who are authorized to pick up from school                        
 
Tuition & Payment                     All classes meet 10:00 am - 12:00 pm
$100 deposit, per child, is due with registration by credit card.  
The deposit will be deducted from the total tuition.  
Tuition includes books.
 
Grades K-5                                   $ 885   
      Indicate # of children    
                                                               Total Tuition for the year:   
 
Tuition may be paid in 10 payments (August 1, 2018 - May 1, 2019) or in full by August 1, 2018
By registering your child(ren) you are agreeing to the tuition payment schedule indicated below
and your credit card will be charged accordingly.
If you would like to pay the monthly payments by check, please call the office at 994-6257.
Card Holder Name Card Holder Address:
Credit Card Number Total to charge at Registration
Exp Date

Tuition Payment Schedule:
Indicate how tuition will be paid.
1 payments or 10

Enrollment Agreement
To enroll your child(ren) in East Boca Hebrew School all forms must be submitted with the required fees.  
 
Enrollment is considered to be for the entire school year.  The school cannot issue refunds or credits for illness, holidays, family vacations or early withdrawal.  In the event that the school is closed due to or resulting from a weather emergency or other unforeseen circumstances, there will be no make-up days, refunds or credits for days that school is not in session.
 
Upon processing a tuition payment, if sufficient funds are not available or the credit card is not approved, your account will be charged $25 for each transaction that could not be processed.
 
Parent(s) acknowledge that East Boca Hebrew School serves children who are able to function successfully in a group setting. If, in the judgment of the school's Director, the child is not able to function in a group setting, the parent may be asked to withdraw the child. In the event that the parent is requested to withdraw the child, the Director will work with the parent to identify possible alternative programs suitable for the child.
 

We give permission to use photographs of our child(ren) in print materials, on our website and/or emails.  Last names of children are never listed.  We give permission for our name and telephone number to be include in any class list that may be distributed. 

Medical and Developmental History
Does your child's (indicate which child) have any medical, developmental or behavioral issue that we should know about? Describe:
Medical Emergencies
I authorize the director or director's designee to seek appropriate medical care for my child, if necessary.
A. In case of emergency, when neither parent can be reached, give names of two people who will take responsibility for your child:
Emergency Contact 1   Emergency Contact 2  
Name Name
Home Phone Home Phone
Cell Phone Cell Phone
Address Address
City City
Relationship to Student Relationship to Student
B. If parents cannot be reached and emergency medical advice is needed, permission is given to the Hebrew School staff to phone my child's doctor:
Doctor Phone
Address City
Hospital Affiliation    
C. In case of medical emergency requiring immediate emergency care, I authorize the paramedics to take my child to the nearest hospital if necessary. It is understood that I will hold Chabad of East Boca and East Boca Hebrew School harmless for the nature and outcome of any emergency medical treatment. It is also understood that I leave the decision of what constitutes an emergency to the sole direction of the staff.
 
By submitting this form, and signing below, parents accept the terms outlined above and agree to the charges on the credit card for the deposit and tuition.  Please sign (type) and date.
Mother's name typed in Date
Father's name typed in Date