Online Application We are currently accepting application forms for the 2021-2022 school year. Please fill out ALL fields of this form. If you have any questions or concerns you'd like to discuss with us, please contact us. ** Please Note - Acceptance to the school is pending director's approval. Student Profile #1 First Name Last Name Hebrew Name Gender Select Female Male DOB Month Jan. Feb. Mar. Apr. May Jun. Jul. Aug. Sept. Oct. Nov. Dec. Date 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Year 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 School Grade Entering (Sept. 2020) Grade Entering Kindergarten 1 2 3 4 5 6 7 Student Profile #2 First Name Last Name Hebrew Name Gender Select Female Male DOB Month Jan. Feb. Mar. Apr. May Jun. Jul. Aug. Sept. Oct. Nov. Dec. Date 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Year 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 School Grade Entering (Sept. 2020) Grade Entering Kindergarten 1 2 3 4 5 6 Student Profile #3 First Name Last Name Hebrew Name Gender Select Female Male DOB Month Jan. Feb. Mar. Apr. May Jun. Jul. Aug. Sept. Oct. Nov. Dec. Date 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Year 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 School Grade Entering (Sept. 2020) Grade Entering Kindergarten 1 2 3 4 5 6 7 Parent Information Father's Name Mother's Name Address City, State, Zip Phone Cell Phone Mother Cell Phone Father E-mail Address Mother E-mail Address Father Are both parents Jewish? Yes No To your recollection have there been any conversions or adoptions in the family? No Yes If yes please explain : Tuition: Kindergarten $500 First Grade $500 Second Grade $500 Third Grade $500 Fourth Grade $500 Fifth Grade $500 6th & 7th Grade $500 Payment Options Pay Full Tuition now. Four payments, August 15, 2021, October 15, 2021, December 15, 2021, and February 15, 2022 Name on Card: Card Type Select MasterCard Visa Amex Discover Card Number Exp. Date Month Jan. Feb. Mar. Apr. May Jun. Jul. Aug. Sept. Oct. Nov. Dec. Year 2021 2022 2023 2024 2025 2026 2027 2028 2029 2030 CCV Number (on back of card) Comments (optional) We hire and make commitments to our staff based on registrations received, and therefore we absolutely cannot refund any deposit or tuition payments. I understand that my deposit of $100 per child is non-refundable, that full payment or payment plan is due by September 1, 2020, at which time the balance of tuition becomes non-refundable, and that refunds will not be made for incomplete attendance. The parent/guardian who signs this registration form represents that he/she has full authority to do so and will be responsible for payment of the Hebrew School fees. I Accept Name: Date: We look forward to a wonderful year of learning and growth! ~~ If needed, please call us at 847-808-7770, for a paper copy of the registration form. This page uses 128 bit SSL encryption to keep your data secure.