Hebrew School; Israeli Style

Family Information
Last Name*
Mom's First Name*
Dad's First Name*

Address*

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

Mom's E-mail*
Dad's E-mail*
Mom's Phone Number*
Dad's Phone Number
Marital Status*

MarriedDivorcedSeperatedWidowed
How did you hear about us?

EmailWeb SearchMailFriendSocial Media
I hereby grant permission to the school to transport my child(ren) for school functions or in case of an emergency.*

YesNo
Child #1 Information
English Name*
First Name Last Name
Hebrew Name
First Name Last Name
Birth Date*

Month Day Year
Age*
Gender*

MaleFemale
Grade for 26-27 school year*
Child #2 Information
English Name
First Name Last Name
Hebrew Name
First Name Last Name
Birth Date

Month Day Year
Age
Grade for 26-27 school year
Gender

MaleFemale
Child #2 Information
English Name
First Name Last Name
Hebrew Name
First Name Last Name
Birth Date

Month Day Year
Age
Grade for 26-27 school year
Gender

MaleFemale
Emergency Doctor Name & Tel #*
Family Emergency Contact Name & Tel #*
Learning, Medical, or Allergic Concerns (If applicable):
Is biological mother Jewish?*

YesNo
Adoptions or Conversions?*

YesNo
Hebrew School runs from September through May

Sessions are held weekly on Tuesdays from 4:30- 6:00 pm

Please check the payment option of your choice:
Payment Options*

Full Payment - $900Two Payments - $450 (second payment on Nov 1)Four Payments - $225 (additional payments on Oct 1, Nov 1, and Dec 1)Two Children; Full payment ($75 off)- $1725Two children; two payments ($75 off)- $862.50Two Children Four Payments ($75 off)- $431.25Three Children; full payment ($100 off)- $2900Three Children; two payments ($100 off)- $1450Three Children' three payments ($100 off)- $967I will speak to Rabbi Yaras to arrange a payment plan. Registration is NOT garunteed without a first payment.
Security Fee- Mandatory*

$100 anuallytwo children- $200three children- $300
Sponsor another child in Hebrew School

Full tuition- $900Half Tution- $450One Month- $100

Payment

Credit Card

We accept Visa, MasterCard, American Express, Discover
Credit Card Number	Security Code
Name on Card
Expiration Month	Expiration Year

Total

$0.00
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Parent Signature
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Hebrew School; Israeli Style

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Child #1 Information

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Child #2 Information

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