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Registration

PAYMENT INFORMATION
•Tuition for Sept 2018-June 2019 is $850 * per child. Book fees are included.
•A tax deductible donation receipt will be issued for the full amount.

*This includes $250 registration and book fee which is non-refundable.
Hebrew School Location*
Dublin Heights (Wednesdays 3:00-5:00pm)Faywood ABC (Mondays 3:15-5:15pm)
Student Information
Student's Full Name*
First NameLast Name

Home Address*

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

Hebrew Name*
Home Phone Number*
Area CodePhone Number
Gender*
FemaleMale
Birth Date*
MonthDayYear
Age (as of Sep 1, 2018)*
Grade (as of Sep 1, 2018):*
Has your child attended Hebrew School in the past?*
YesNo
Does your child read basic Hebrew?*
YesNo
If Yes, How well?
Which school does your child attend?*
Parent Information
Parent's Marital Status*
Father's Name*
PrefixFirst NameLast Name
Father's E-mail*
Father's Cell Phone*
Area CodePhone Number
Father's Work Phone
Area CodePhone Number
Mother's Name*
PrefixFirst NameLast Name
Mother's E-mail*
Mother's Cell Phone*
Area CodePhone Number
Mother's Work Phone
Area CodePhone Number
Is the natural mother of the child Jewish?*
YesNo
Were there any Jewish Conversions in your family?*
YesNo
If yes, please provide details:
Were there any adoptions in your family?*
YesNo
Does your family have membership with a Synagogue?*
YesNo
If yes, please specify:
Payment Information
Hebrew School Fee*
$850
Total
$0.00

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

Comments
Should be Empty:

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