Hebrew School Registration

Parents Information
Father's Name*
First Name Last Name
Father's Cell*

Area Code Phone Number
Father's E-mail*
Mother's Name*
First Name Last Name
Mother's Hebrew Name
Mother's Cell*

Area Code Phone Number
Mother's E-mail

Address*

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

Best way to send Hebrew School updates:**

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I am willing to assist in school activities, please contact me
Student Information
Student Profile #1
Full Name*
First Name Last Name
Hebrew Name
School*
Previous Jewish Education
Grade entering*
Birth Date*

Month Day Year
Additional notable Information Please let us know if there are any allergies or other important information we need to be aware of.
Is the childs biological mother Jewish?

Yes, by birth.Yes through orthodox conversion (Please specify below).Other (Please specify below)
Please specify here: If there are any conversions in the family please specify them as well.
Student Profile #2
Full Name*
First Name Last Name
Hebrew Name
School*
Previous Jewish Education
Grade entering*
Birth Date*

Month Day Year
Additional notable Information Please let us know if there are any allergies or other important information we need to be aware of.
Is the childs biological mother Jewish?

Yes, by birth.Yes through orthodox conversion (Please specify below).Other (Please specify below)
Please specify here: If there are any conversions in the family please specify them as well.
Student Profile #3
Full Name*
First Name Last Name
Hebrew Name
School*
Previous Jewish Education
Grade entering*
Birth Date*

Month Day Year
Additional notable Information Please let us know if there are any allergies or other important information we need to be aware of.
Is the childs biological mother Jewish?

Yes, by birth.Yes through orthodox conversion (Please specify below).Other (Please specify below)
Please specify here: If there are any conversions in the family please specify them as well.
Payment
Price per child $450. $100 discount per each additional child (i.e. second child $350, third child $250 etc.)
No child will be turned away due to lack of funds. Please reach out for scholarships or discounts.
How would you like to pay?

Full Payment OptionsInstallment Payment Options (Three Installments - Due by Oct 1, Nov 1, Dec 1)
Please Select:

1 Child: $4502 Children: $8003 Children: $1050Other
Please note: We will follow up with you directly via email.
Please Select:

1 Child2 Children3 Children

Payment* Payment plans available upon request

Credit Card Cheque or Other

Postal / Zip Code

Country

RELEASE OF INFORMATION AND PHOTOGRAPHS
Parents allow for child's picture to be used for internal PR mailing and website where name is not given. Parents allow for child's photograph/name released to newspapers where last name will not be given. If not, please contact us.
Print Name* I agree to terms and conditions
I would like to receive news and updates by email
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Educate Your Child... Educate a Generation

Parents Information

Student Information

Payment