School Year 2026-27 Returning Student Registration Family Name* Street Address City, State, Zip Child #1 1. Child's Full Name* 1. Hebrew Name 1. Birth Date* 1 - January2 - February3 - March4 - April5 - May6 - June7 - July8 - August9 - September10 - October11 - November12 - December Month12345678910111213141516171819202122232425262728293031 Day20262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920 Year 1. Grade Entering 08/26* Kdg1st2nd3rd4th5th6th7th8th 1. Any changes to medical or any other pertinent information?* NoYes 1. If yes, please explain changes: Child #2 2. Child's Full Name 2. Hebrew Name 2. Birth Date 1 - January2 - February3 - March4 - April5 - May6 - June7 - July8 - August9 - September10 - October11 - November12 - December Month12345678910111213141516171819202122232425262728293031 Day20262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920 Year 2. Grade Entering 08/26 Kdg1st2nd3rd4th5th6th7th8th 2. Any changes to medical or any other pertinent information? NoYes 2. If yes, please explain changes: Child #3 3. Child's Full Name 3. Hebrew Name 3. Birth Date 1 - January2 - February3 - March4 - April5 - May6 - June7 - July8 - August9 - September10 - October11 - November12 - December Month12345678910111213141516171819202122232425262728293031 Day20262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920 Year 3. Grade Entering 08/26 Kdg1st2nd3rd4th5th6th7th8th 3. Any changes to medical or any other pertinent information? NoYes 3. If yes, please explain changes: Child #4 4. Child's Full Name 4. Hebrew Name 4. Birth Date 1 - January2 - February3 - March4 - April5 - May6 - June7 - July8 - August9 - September10 - October11 - November12 - December Month12345678910111213141516171819202122232425262728293031 Day20262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920 Year 4. Grade Entering 08/26 Kdg1st2nd3rd4th5th6th7th8th 4. Any changes to medical or any other pertinent information? NoYes 4. If yes, please explain changes: Parents' Information Father's Name* Father's E-mail* Father's Cell* Mother's Name* Mother's Email* Mother's Cell* 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. Emerg. Contact - Full Name* Relationship to Child* Emerg. Contact - Cell Number* Fees and Payment Information These prices are effective through May 31, 2026. Beginning June 1, 2026, tuition will increase to $1220. Registration & Book fee: $50/child Tuition: $1120 note: We give you a 10% tuition discount for your younger child(ren). Total Tuition and Fees:* 1 Child = $11702 Children = $1170 + $10583 Children = $1170 + ($1058 x 2)4 Children = $1170 + ($1058 x 3) 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 FullNine Monthly Installments (September - May) Payment* Credit Card Paypal Check Credit Card We accept Visa, MasterCard, American Express, Discover Credit Card Number Security Code Name on Card1 - January2 - February3 - March4 - April5 - May6 - June7 - July8 - August9 - September10 - October11 - November12 - December Expiration Month2026202720282029203020312032203320342035 Expiration YearPaypal has been selected. 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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 Should be Empty: This page uses TLS encryption to keep your data secure.