New Student Registration - Simcha Educational Center

School Year 2026-27

New Student Registration

Please complete one form for each child.

Family Name*

Street Address*

City, State, Zip*

Student Information

Child's Full Name*

Child's Hebrew Name

Gender*

MaleFemale

Birth Date*

Month Day Year

Grade entering 08/26*

School Attending*

Previous Hebrew School Education

Name of previous Hebrew School (Or indicate none)*

Dates Attended

How proficient is your child in reading Hebrew?*

Doesn't readFairPoorGood

Does your child have any learning difficulties with general studies?*

NoYes

If yes, please explain difficulties

Is there any medical or important information we should be aware of?*

NoYes

If yes, please explain information

Were there any conversions or adoptions in the family?*

NoYes

Conversions or adoptions

Is the child's natural mother Jewish?*

NoYes

Is your family affiliated with a synagogue?*

NoYes

If yes, which synagogue

Parent's Information

Father's Name*

Father's Hebrew name

Father's E-mail*

Father's Cell*

Father's Address *If different from above

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

Mother's Name*

Mother's Hebrew name

Mother's Email*

Mother's Cell*

Mother's Address *If different from above

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

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.

Emerg. Contact - Full Name*

Relationship to child*

Emerg. Contact - Cell Number*

Family Doctor*

Doctor's Phone Number*

Fees and Payment Information

Registration & Book fee: $50/child
Tuition: $1220/child; $610/child for new families
New Families receive a 50% tuition discount.
Returning Families: 10% tuition discount for additional children.

We are a new family.

We are a returning family.

New Family Tuition & Fees: $660*

One Payment $660Eight payments. $100 today, then $80 monthly

Returning Family Tuition & Fees: $1270*

One Payment $1270Eight payments. $220 today, then $150 monthly

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 Full9 Monthly Installments (September - May)

Payment*

Credit Card Paypal Check

Postal / Zip Code

Country

Comments

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*