Hebrew School Registration - New

Family Information
Family Name*

Address*

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

Father's Name*

First Name Last Name
Father's Hebrew Name (if available)
Father's E-mail*
Father's Cell Phone*

Area Code Phone Number
Mother's Name*

First Name Last Name
Mother's Hebrew Name (if available)
Mother's E-mail*
Mother's Cell Phone*

Area Code Phone Number
Parent's Marital Status?*
Any conversions in the family? If yes, please specify.*
Is the Father Jewish?*

Yes No
Is the Mother Jewish?*

Yes No
Child 1 Information
Name*
Hebrew Name
Birth Date and Time* Time of day allows us to calculate Hebrew birthdate.

Month Day Year
at Hour Minutes
School Attending*
Grade Entering*
Is the Child adopted?*

No Yes
Needs epi-pen?* If yes, please include details below.

No Yes
Please list any allergies and/or regular medications.
Child 2 Information
Name
Hebrew Name
Birth Date and Time Time of day allows us to calculate Hebrew birthdate.

Month Day Year
at Hour Minutes
School Attending
Grade Entering
Is the Child adopted?

No Yes
Needs epi-pen? If yes, please include details below.

No Yes
Please list any regular medications, allergies, and/or epi-pen specifications.
Child 3 Information
Name
Hebrew Name
Birth Date and Time Time of day allows us to calculate Hebrew birthdate

Month Day Year
at Hour Minutes
School Attending
Grade Entering
Is the Child adopted?

No Yes
Needs epi-pen? If yes, please include details below.

No Yes
Please list any regular medications, allergies, and/or epi-pen specifications.
Please list name(s) of those (other than parents) who are authorized to pick up from school
Tuition and Payment
All classes meet 10:00 am - 12:00 pm.

Tuition for grades K - 8: $700 per child.

A $100 deposit, per child, is due with registration by credit card.
The deposit will be deducted from the total tuition.
Tuition includes books.

Tuition may be paid in 8 payments (October 2020 - May 2021) or in full by October 25, 2020
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.
Please Select One*

Full tuition for one child (includes deposit) Full tuition for two children (includes deposit) Full tuition for three children (includes deposit) Deposit for one child (balance to be charged monthly) Deposit for two children (balance to be charged monthly) Deposit for three children (balance to be charged monthly)
Total

$0.00

Yes, I'd like to donate the cost of processing this transaction by adding 3%

Payment

Credit Card

Credit Card Type
Credit Card Number	Security Code
Name on Card
Expiration Month	Expiration Year

Billing Address

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Country

Should be Empty:

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Family Information

Child 1 Information

Child 2 Information

Child 3 Information

Tuition and Payment