New Students

Child's Name*

First Name Last Name

Hebrew Name*

Gender*

Male Female

Birth Date

Month Day Year

at Hour Minutes

School*

Grade entering*

Previous Jewish Education*

Our warm and caring staff are here to support your child and bring out the best in them. Please take the time to tell us about your child. Describe his/her talents. Tell us what helps your child learn well. We are looking forward to caring for your child and watching him/her grow!*

Medical Information- Up to date with Vaccinations?*

Yes No

Medical Information - Any Medical Challenges? Include any allergy information.*

Yes No

If Yes please explain

Child's Name

First Name Last Name

Hebrew Name

Gender

Male Female

Birth Date

Month Day Year

at Hour Minutes

School

Grade entering

Previous Jewish Education

Our warm and caring staff are here to support your child and bring out the best in them. Please take the time to tell us about your child. Describe his/her talents. Tell us what helps your child learn well. We are looking forward to caring for your child and watching him/her grow!*

Medical Information- Up to date with Vaccinations?

Yes No

Medical Information - Any Medical Challenges? Include any allergy information.

Yes No

If Yes please explain

Marital Status

Married Separated Divorced

Affiliation/Synagogue

Father's Name*

First Name Last Name

Father's Hebrew Name

Father's Occupation

Father's Cell*

Area Code Phone Number

Father's E-mail*

Mother's Name*

First Name Last Name

Mother's Hebrew Name

Mother's Occupation

Mother's Cell*

Area Code Phone Number

Mother's E-mail*

Parent's Address*

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

Is the natural mother of the child Jewish?*

Yes No

Is the maternal grandmother Jewish?*

Yes No

Have there been any conversions or adoptions in the family?*

Yes No

If yes please explain

All Hebrew school notifications and calendar reminders will be sent via email and/or text message. Please be sure our email address is in your primary message folder. Please also include a phone number that receives SMS and Whatsapp messages. Pictures and videos are updated to our website via Facebook. LIKE our page for instant updates!

E-mail

Phone Number

Area Code Phone Number

Family Physican*

First Name Last Name

Physican Phone*

Area Code Phone Number

Emergency Contact 1*

First Name Last Name

Emergency Contact 1 Phone*

Area Code Phone Number

Emergency Contact 1 Relationship to Child*

Emergency Contact 2*

First Name Last Name

Emergency Contact 2 Phone*

Area Code Phone Number

Emergency Contact 2 Relationship to Child*

Please check the programs you would like to gift your child with

Hebrew School {Ages 5-13} Sundays 10:00-12:15 $900 $150 School Security Guard Fee per student 10% discount for each additional sibling $100 Tuition Credit for referring a new family

I heard about the Hebrew School from

Our state-of-the-art Jewish youth programs are here to serve you! Please describe what you are mostly looking forward to this coming school year.*

Permission Form*

I agree that if parents cannot be reached and emergency medical advice is needed, permission is granted to contact my child's doctor I agree that in case of medical emergency requiring immediate emergency care, I authorize transportation to nearest medical facility. I agree that during the course of our child[ren]'s instruction we recognize that field trips and activities other than classroom instruction will be provided by your staff and agents of the School. We understand that these additional activities are deemed necessary by the Synagogue FREE Hebrew School to provide our child[ren] with a full Jewish education and experience. I, the legal parent/guardian, authorize you and your agents to involve our child in these various trips and activities, direct you to rely upon the registration forms previously tendered for emergency contact persons for the benefit of our child[ren], authorize the administration of any medicines deemed necessary by emergency health professionals in the event of non-availability of parent/guardian, acknowledge that all known allergies or other conditions impacting the health and well-being of our child[ren] are listed above, and further release the Synagogue FREE Hebrew School and its agents from liability arising during the course of these various field trips and activities. I/we understand that my/our child[ren] may be included in photographs and video footage that may be photographed or filmed during Hebrew School. I authorize the Synagogue FREE Hebrew School to use these photos/videos to promote its programs and services in print, web, and other promotional contexts.

Registration Fee* A non-refundable $150 deposit toward the total tuition will be processed as part of your registration. This is not an additional charge.

$150

I would like to assist a child who cannot afford Hebrew School Education.

$180 $360 $540

Please Choose Payment Plan*

Full Payment 50% Payment September 1st and 50% Payment January 1st 10 Installments

Total

$0.00

Payment

Credit Card Check

Postal / Zip Code

Country

Digital Signature*

Date*

Month Day Year

The Synagogue FREE Hebrew School

Child 1

Child 2

Parents Information

Emergency Information

Programs

Payment