Returning Student Registration

Please complete this form to indicate your child's return to Discovery Hebrew School. For your convenience, only starred fields need to be completed. Please fill in any other field that should be updated since last year. Thank you!
CONTACT:
Number of Children Being Registered:*
Child Name:*

First Name Last Name
School Currently Attending:
Any considerations, such as learning disorder or difficulty, the school should be aware of? (Confidential)
Child 2 Name:
Child 2 School Currently Attending:
Any considerations, such as learning disorder or difficulty, the school should be aware of? (Confidential)
Child 3 Name:
Child 3 School Currently Attending:
Any considerations, such as learning disorder or difficulty, the school should be aware of? (Confidential)
PARENTS:
Mother's Info
Mother's Full Name:*

First Name Last Name
Mother's Occupation:
Mother's Cell Phone Number:

Area Code Phone Number
Mother's E-mail:
Father's Info
Father's Full Name*

First Name Last Name
Father's Occupation:
Father's Cell Phone Number:

Area Code Phone Number
Father's E-mail

Address:

Would you be interested in Hebrew School Family Programming?*

Yes, Please!Maybe sometimesNah, not for us
How often?*

Once a monthEvery 6 weeksEvery Other MonthTwice a Year
What kinds of Family Programming would you be interested in?*

At a parkAt JDCAt a parent's houseAny other venues.
PAYMENT INFORMATION

Registration Fee: $50/student Pay in Full: $895/Child Early Bird: $795/Child
Current Date

Month Day Year
at Hour Minutes
Payment Options:* Early Bird before July 1

1 Child Full Payment $7952 Children Full Payment $15903 Children Full Payment $2385Just Pay Registration Fee
Payment Options:*

1 Child Full Payment $8952 Children Full Payment $17903 Children Full Payment $2685Just Pay Registration Fee
Donation: I'd like to give a student in need a chance to receive a Hebrew School education

$54.00$90.00$180.00$360.00$650.00
Total:

$0.00

Yes, I'd like to donate the cost of processing this transaction by adding 3%

Payment:*

Credit Card

We accept Visa, MasterCard, American Express, Discover
Credit Card Number	Security Code
Name on Card
Expiration Month	Expiration Year

Billing Address

Street Address

City

State / Province

Postal / Zip Code

Country

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CONTACT: