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Hebrew School Registration

Child 1
Child's Name*
First NameLast Name
Hebrew Name*
Birth Date*
MonthDayYear
School*
Grade entering*
Child 2
Child's Name
First NameLast Name
Hebrew Name
Birth Date
MonthDayYear
School
Grade entering

Addressonly fill in if different than billing address

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

Additional notable Information
Parents Information
Father's Name*
First NameLast Name
Father Cell*
Area CodePhone Number
Mother's Name*
First NameLast Name
Mother Cell*
Area CodePhone Number
E-mail*
Is Mother*
Jewish by BirthConverted
If converted, please specify Rabbinic Authorization:
Is Maternal Grandmother*
Jewish by BirthConverted
If converted, please specify Rabbinic Authorization:
Tuition Fee
Members:
Sundays (1 kid) - $400Sundays (2 kids) - $725
Non Members:
Sundays (1 kid) - $450Sundays (2 kids) - $825
Total Amount*
$0.00
Payment Options:*
Pay in full4 Payments - Monthly8 Payments - Monthly

Payment*

Credit Card

Credit Card Type
Credit Card Number	Security Code
Name on Card
Expiration Month	Expiration Year

Billing Address

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Country

Should be Empty:

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Photo Gallery

Hebrew School Photos

karol galan.gif

Karol Galan Z"L