Hebrew School Registration 2016-2017
Wednesdays 3:30-5:00 pm
Child's name
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Child's DOB
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Child's Hebrew Name
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Entering School Grade in 2016-17?
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Please sign my child up for:
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Child's name (additional)
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Child's DOB (additional)
MM
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DD
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YYYY
Child's Hebrew Name (additional)
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Entering School Grade in 2016-17? (additional)
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Address
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Zip
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Please sign my child up for: (additional)
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Mother's name
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Mother's Hebrew name
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Mother's email
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Mother's cell phone
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Mother's occupation
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Is Mother Jewish?
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Father's name
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Father's Hebrew name
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Father's email
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Father's cell phone
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Father's occupation
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Is Father Jewish?
Required
Are there any conversions in your immediate or extended families?
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I am interested in Hebrew School for my child because...
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Does your child have any learning difficulties?
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If yes, please explain.
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Any medical conditions or related regarding your child we should be aware of?
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If yes, please explain
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Emergency Contact Information: Name
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Emergency Contact Information: Phone Number
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Emergency Contact Information: Relationship
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I hereby permit my child to participate in all school activities. I am aware that photos and videos taken during Hebrew school may be used in promotional material. In case of emergency, I hereby authorize the school to have my child taken care of by a physician in any way the situation may call for.
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I understand that Hebrew School Tuition is a yearly amount of $700 due at the start of Hebrew School or in 2 payments of $350 payable in September and December.
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