Child Name Hebrew Name Birth DateSchool Grade in September Parents Names Address: Street AddressStreet Address Line 2CityPostal / Zip CodeHome Phone: Area Code - Phone Number Mothers Cell Area Code - Phone Number Fathers Cell Work Phone E-mail:THIS SECTION MUST BE FILLED OUTIN CASE OF EMERGENCY NOTIFYEMERGENCY NAME Emergency Phone Area Code - Phone Number Physician Name Physician Number Area Code - Phone 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 permissionSignature Date:FEE SCHEDULE FOR 2018- 2019Mechina (ages 6-7) Wednesdays 4:30-6PM - $125Gozaleem (ages 8-10) Wednesdays 4:15-6:15PM $300We will be dividing the Gozaleem into two groups, based on age and Hebrew reading experience.Pre-Bar/Bat Mitzvah (ages 11-12) Wednesdays 4:15-6:15PM $300This class in formation. Contact us for details.Hebrew School Fees are due prior to the start of classes.No student will be permitted to attend class unless all fees are paid.Pay via check made out to Lake Success Jewish Centeror via credit card at www.lakesuccessjc.org/donate. SubmitReset
