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New Students

New Students

Student Information
CHILD 1
Last Name
First Name
Hebrew Name
Gender
Male Female
Date of Birth

Time of Birth
Please specify:
AM PM

School

Grade
 
Previous Jewish education?
Yes No
If Yes, please describe  
Medical Information -
Up to date with vaccinations?
Yes No
Medical Information -
Any Medical Challenges?
Yes No
 
If Yes please explain
CHILD 2
Last Name
First Name
Hebrew Name
Gender
Male Female
Date of Birth
Time of Birth
Please specify:
AM PM
School
Grade
 
Previous Jewish education?
Yes No
If Yes please describe
 
Medical Information -
Up to date with vaccinations?
Yes No
Medical Information -
Any Medical Challenges?
Yes No
 
If Yes please explain
CHILD 3
Last Name
First Name
Hebrew Name
Gender
Male Female
Date of Birth

Time of Birth
Please specify:

AM PM

School
Grade
 
Previous Jewish education?
Yes No
If Yes please describe
 
Medical Information -
Up to date with vaccinations?
Yes No
Medical Information -
Any Medical Challenges?
Yes No
 
If Yes please explain
Parent Information
Marital Status
Affiliation/Synagogue
 

Father

Title/First Name
Last Name
Hebrew Name
Cell Phone
Work Phone
Email
Occupation
   
Mother
Title/First Name
Last Name
Hebrew Name
Cell Phone
Work Phone
Email
Occupation
   
Parents
Address
City/State/ Zip
Home Phone
Is the natural mother of the child Jewish? Yes No
Maternal grandmother? Yes No
Have there been any conversions or adoptions in the family? Yes No
If yes please explain

All Hebrew school notifications and calendar reminders will be sent via email and text message. Please be sure our email address is in your primary message folder. Please also include a phone number that receives text messages. Pictures and videos are updated to our website via Facebook. LIKE our page for instant updates!

Emergency Information
Family Physician
Name
Phone #
 
Emergency 1
Name
Phone #
Relation
Emergency 2
Name
Phone #
Relation
Programs
Please check the program you would like your child to attend:
Pre Hebrew School – ages 3-5
Sunday Mornings 10:00 AM – 1:00 PM
Hebrew School – ages 6-9
Sunday Mornings 10:00 AM – 1:00 PM
Bar/ Bat Mitzvah – ages 10-13
Sunday Mornings 10:00 AM – 1:00 PM
10% Discount for each additional sibling
5% Discount for referring a new family
Payment Information
Please Choose Payment Plan
Please Choose Payment Method
A non-refundable $150 deposit toward the total tuition will be processed as part of your registration.
Please make checks payable to FREE. All 10 post-dated checks must be turned in with registration.
Card Number
Name on Card
Expiration Date
Security Code
Billing Address
Billing Zip
I would like to assist a child who cannot afford Hebrew School Education.
Permission Form

As the parent(s) or legal guardian of the above child/ren, I/we authorize any adult acting on behalf of Synagogue FREE Hebrew School to hospitalize or secure treatment for my/our child/ren, I/we further agree to pay all charges for that care and/or treatment. It is understood that if time and circumstances reasonably permit, Synagogue FREE Hebrew School personnel will try, but are not required, to communicate with me/us prior to such treatment. I/we hereby give permission for my/our child/ren to participate in all school activities, join in class and school trips on and beyond school properties, and further release the School and its agents from liability arising during the course of these various field trips and activities. And I/we understand that my/our child/ren may be included in photographs and video footage that may be photographed or filmed during Hebrew School. I authorize the Synagogue FREE Hebrew School to use these photos/videos to promote its programs and services in print, web, and other promotional contexts.

Our Hebrew School is here to serve you! Please describe what you are mostly looking forward to this coming school year.
I heard about the Hebrew School from
Digital Signature Date

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For more information please contact us 847-315-0068 or email Hebrewschool@obshina.com