B"HHebrew School Registration - Returning Students School Year 2022 - 23Please complete one form per family.Family name*AddressCity, State, ZipChild #1 Full Name*Child #1 Hebrew NameChild #1 Birthdate*MonthDayYear Child #1 grade entering in 8/22*Child #2 Full NameChild #2 Hebrew NameChild #2 BirthdateMonthDayYear Child #2 grade entering in 8/22Father's name*Father's email address*Father's cell phone*Mother's name*Mother's email address*Mother's cell phone*Emergency InformationPlease list a LOCAL person who may be contacted to pick up your child in case of an emergency when the parents cannot be reached.Emergency Contact Name*Emergency Contact relationship to child*Emergency Contact cell phone #*Any changes in medical or other pertinent info? If yes, please explain.*Fees and Payment InformationRegistration & Book fee: $50/childTuition: $900 note: We give you a 10% tuition discount for your second child.Tuition & Fees for Child #1*$950Tuition & Fees for Child #2 (with sibling discount already calculated)$860Total$0.00Yes, I'd like to donate the cost of processing this transaction by adding 3%Indicate your choice of Payment Plan*one payment in full2 installments (September & January)9 monthly installments (September - May)Payment*Credit Card Paypal Check or Credit Card on file Credit CardVisaMasterCardAmerican ExpressDiscoverCredit Card TypeCredit Card NumberSecurity CodeName on Card1 - January2 - February3 - March4 - April5 - May6 - June7 - July8 - August9 - September10 - October11 - November12 - DecemberExpiration Month2022202320242025202620272028202920302031Expiration YearPaypal has been selected. Payment will take place on the next page.We will automatically use your cc info in our system. If you prefer to send a check please note in payment instructions.Payment InstructionsPermission*I hereby permit my child to participate in all school activities and to participate in class and school trips on and beyond school properties. In case of an emergency, I hereby authorize the school to have my child given care by a physician in the manner in which the situation dictates.Signature*Submit Clear FormShould be Empty: This page uses TLS encryption to keep your data secure.