ב"ה

Returning Student Registration

School Year 2024-25

Returning Student Registration
Family Name*
Street Address
City, State, Zip
Child #1
1. Child's Full Name
1. Hebrew Name
1. Grade Entering 08/24*
1. Birth Date*

Month Day Year
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. Grade Entering 08/24
2. Birth Date

Month Day Year
2. Any changes to medical or any other pertinent information?

NoYes
2. 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 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*
Fees and Payment Information

Registration & Book fee: $50/child
Tuition: $1095
note: We give you a 10% tuition discount for your second child.

Prices effective July 1, 2024.
Total Tuition and Fees:*
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 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*
Should be Empty:

This page uses TLS encryption to keep your data secure.