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Returning Student Registration

Address*

Child #1
Full Name*

First Name Last Name
Hebrew Name
1. Grade Entering 08/23*
Birth Date*

Month Day Year
Child #2
Full Name

First Name Last Name
Hebrew Name
2. Grade Entering in 08/23
Birth Date

Month Day Year
Parents' Information
Fathers' Name*

First Name Last Name
Father's E-mail*
Father's Cell*
Mother's Name*

First Name Last Name
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.
Full Name*

First Name Last Name
Relationship to Child*
Phone Number*
Any changes to medical or any other pertinent information?*
Fees and Payment Information

Registration & Book fee: $50/child
Tuition: $945
note: We give you a 10% tuition discount for your second child.

Prices valid through June 30, 2023. Tuition will increase to $945 effective July 1, 2023.
Tuition and Fees for Child #1*

$995
Tuition & Fees for Child #2 (with sibling discount already calculated)

$900
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 FullTwo Installments (September and January)Nine 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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