New Student Registration - SimchaEdCenter.com

School Year 2024-25

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 08/24*

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 adoption:

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 Address *If different from above

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

Father's E-mail*

Father's Cell*

Mother's Name*

Mother's Hebrew name

Mother's Address *If different from above

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

Mother's Email*

Mother's Cell*

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: $1095/child; $547/child for new families
Note: For new families, we give a 50% tuition discount.
For returning families, we give a 10% tuition discount for additional children.

Total Tuition and Fees:*

$1035 for Returning Family$597 for New Family

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 or Credit Card on File

Postal / Zip Code

Country

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*