Register

Please fill out this form as an initial registration for the Discovery Hebrew School.

Confirmation of acceptance will be acknowledged only after this registration form is reviewed and an acceptance letter is received.

Full Name*

First Name Last Name

Hebrew Name:*

Age*

Birth Date*

Month Day Year

Gender:*

School Currently Attending:*

Grade entering in September:*

Hebrew Reading Proficiency*

None Somewhat Well

Does your child speak/understand Hebrew?*

None Somewhat Well

Previous Jewish Education*

Yes No

Where?

Were there any conversions or adoptions in your family?*

Yes No

If yes, please describe (Confidential)

Any considerations, such as learning disorder or difficulty, the school should be aware of? (Confidential)

Full Name

First Name Last Name

Hebrew Name:

Age

Birth Date

Month Day Year

Gender:

School Currently Attending:

Grade entering in September:

Hebrew Reading Proficiency

None Somewhat Well

Does your child speak/understand Hebrew?

None Somewhat Well

Previous Jewish Education

Yes No

Where?

Any considerations, such as learning disorder or difficulty, the school should be aware of? (Confidential)

Address*

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

Father's Name:*

Father's Occupation:*

Father's Cell Phone Number:*

Area Code Phone Number

Father's E-mail*

Mother's Name:*

Mother's Occupation:*

Mother's Cell Phone Number:*

Area Code Phone Number

Mother's E-mail:*

Emergency Contact 1*

Relationship to Child(ren)*

Home Address*

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

Home Phone Number*

Area Code Phone Number

Work/Cell/Pager*

Additional person authorized to care for child(ren)*

Relationship to Child(ren)*

Address*

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

Home Phone Number*

Area Code Phone Number

Work/Cell/Pager*

Physicians Name*

Physician's Phone Number:*

Area Code Phone Number

Physician's Address*

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

Medical Insurance Company:*

Group #:*

Policy #:*

Up to date with vaccinations?*

Yes No

Date of Last Tetanus Shot*

Month Day Year

CONFIDENTIAL: Does your child have any allergies or other medical condition we should be aware of? If yes, please describe them and indicate special precautions or care needed.*

The following is a tuition agreement for the Discovery Hebrew School. The agreement explains the tuition fees, payments plans and refund policies. Please read it through carefully. If paying by check or cash, full payment must be submitted to the school office before any child will be permitted to attend classes.

The tuition for the Discovery Hebrew School is $540.00 per year per child (this includes a registration & book fee). A $54 deposit must accompany this application to hold a spot for your child (to be applied to your tuition).

Total Amount to be charged today:*

$

Please check box with your choice for method of payment.*

PLAN A: You may pay the entire amount in full with a check, cash or credit card PLAN B: You may pay the annual tuition on a monthly basis by submitting 10 checks of $49.00 each, dated August through May. All checks must be submitted before the first day of Hebrew School. A $25 late fee will be charged for any tuition payments received after the 4th of the month. PLAN C: You may use your credit card to pay the tuition on a monthly basis. Your credit card will be billed $49.00 monthly August through May. To do so please include your credit card number and expiration date at the bottom of this page. A $25 late fee will be charged for any tuition payments received after the 4th of the month.

Total

$0.00

Payment

Credit Card Check

Postal / Zip Code

Country

As the parent(s) or legal guardian of the above child, I/we authorize any adult acting on behalf of Discovery Hebrew School to hospitalize or secure treatment for my child, I further agree to pay all charges for that care and/or treatment. It is understood that if time and circumstances reasonably permit, Discovery Hebrew School personnel will try, but are not required, to communicate with me prior to such treatment. I hereby give permission for my child to participate in all school activities, join in class and school trip on and beyond school properties and allow my child to be photographed while participating in Discovery Hebrew School activities.

Discovery Hebrew School accepts applications from all who feel a connection to Judaism. Acceptance into the Hebrew School program is not conditioned on whether the student or parents are Jewish, nor is it a confirmation of such status. Acceptance of a student in the Hebrew School program is at the sole discretion of the Directors of Discovery Hebrew School.

Refunds for children withdrawing from school before the end of the school year will be pro-rated up to February 1 provided that the school office is given 30 days written notice and does not include a $50 registration and book fee. Tuition refunds will not be granted to children withdrawing from school after February 1. There are no refunds or credits for days missed due to illness, holidays, or family vacations.

*

I accept

Full Name*

First Name Last Name

Initials*

Date*

Month Day Year

We look forward to a wonderful year of learning and growth!

STUDENT 1 INFORMATION

STUDENT 2 INFORMATION

PARENT INFORMATION

EMERGENCY INFORMATION

TUITION AGREEMENT