Hebrew School Application On Line

Child Name
Hebrew Name
Birth Date
School
Grade in September
Parents Names
Address:
Home Phone:
-
Mothers Cell
-
Fathers Cell
Work Phone
E-mail:

THIS SECTION MUST BE FILLED OUT

IN CASE OF EMERGENCY NOTIFY

EMERGENCY NAME
Emergency Phone
-
Physician Name
Physician Number
-

Emergency Consent Form: I the undersigned , the parent or legal guardian of the child named in the registration form, do nearby give authorization for professional medical personal to provide emergency medical treatment in the event that neither parent( guardian) can be contacted for such permission

Signature
Date:

FEE SCHEDULE FOR 2017- 2018

Mechina(ages 5-7)   $125

Gazleem (ages 8-10)  $300

Dalet/Hay  (Agers 11-12) $500

Hebrew School Fees are due prior to the start of classes,

No student will be permitted to attend class unless all fees are paid