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.

Student Profile
Last Name
First Name
Hebrew Name
Sex Male    Female    
Grade Entering
Hebrew Reading Proficiency None    Somewhat    Well
Does your child speak/understand Hebrew? None    Somewhat    Well
Previous Jewish Education Yes            No
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):  


Parent Information
Father's Name
Father's Occupation
Father's Cell
Father's Email
Mother's Name
Mother's Occupation
Mother's Cell
Mother's Email


Emergency Information
Emergency Contact 1
Relationship to Child  
Home Address  
Home Phone
Additional person authorized to care for child
Relationship to Child  
Home Address  
Home Phone
Physicians Name
Physicians Phone Number
Physician's Address  
Medical Insurance Company
Group #
Up to date with vaccinations?   Yes  No
Date of Last Tetanus Shot  

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. 



Tuition Agreement
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 $490.00 per year per child (this includes a registration & book fee). A $50 deposit must accompany this application to hold a spot for your child (to be applied to your tuition).
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.
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.
Method of payment:
 Check  Credit Card  
Payment Informationn
CC Type   Card Number
Billing Address   City, State, Zip   
Charge Amount   Exp  Date  
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    

Name:     Initials:  Date: 

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