2022-23 Returning Student registration form

B"H

Hebrew School Registration - Returning Students
School Year 2022 - 23

Please complete one form per family.

Family name*

Address

City, State, Zip

Child #1 Full Name*

Child #1 Hebrew Name

Child #1 Birthdate*

MonthDayYear

Child #1 grade entering in 8/22*

Child #2 Full Name

Child #2 Hebrew Name

Child #2 Birthdate

MonthDayYear

Child #2 grade entering in 8/22

Father's name*

Father's email address*

Father's cell phone*

Mother's name*

Mother's email address*

Mother's cell phone*

Emergency Information

Please 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 Information

Registration & Book fee: $50/child
Tuition: $900
note: We give you a 10% tuition discount for your second child.

Tuition & Fees for Child #1*

$950

Tuition & Fees for Child #2 (with sibling discount already calculated)

$860

Total

$0.00

Yes, 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

Payment Instructions

Permission*

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*

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