Hebrew School Registration 2016-2017
Wednesdays 3:30-5:00 pm
Child's name *
Your answer
Child's DOB *
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DD
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YYYY
Child's Hebrew Name *
Your answer
Entering School Grade in 2016-17? *
Your answer
Please sign my child up for: *
Required
Child's name (additional) *
Your answer
Child's DOB (additional) *
MM
/
DD
/
YYYY
Child's Hebrew Name (additional) *
Your answer
Entering School Grade in 2016-17? (additional) *
Your answer
Address *
Your answer
Zip *
Your answer
Please sign my child up for: (additional) *
Required
Mother's name *
Your answer
Mother's Hebrew name *
Your answer
Mother's email *
Your answer
Mother's cell phone *
Your answer
Mother's occupation *
Your answer
Is Mother Jewish? *
Required
Father's name *
Your answer
Father's Hebrew name *
Your answer
Father's email *
Your answer
Father's cell phone *
Your answer
Father's occupation *
Your answer
Is Father Jewish? *
Required
Are there any conversions in your immediate or extended families? *
Required
I am interested in Hebrew School for my child because... *
Your answer
Does your child have any learning difficulties? *
Required
If yes, please explain. *
Your answer
Any medical conditions or related regarding your child we should be aware of? *
Required
If yes, please explain *
Your answer
Emergency Contact Information: Name *
Your answer
Emergency Contact Information: Phone Number *
Your answer
Emergency Contact Information: Relationship *
Your answer
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. *
Required
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. *
Required
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