For more information e-mail [email protected] Please submit 1 form per applicant *If your child attended Hebrew School 2022 Fall session, please CLICK HERE to fill out a simplified re-enrollment form. Parent InformationFather's Name*PrefixFirst NameLast NameFather's E-mail*Father's Cell Phone*Area CodePhone NumberFather's Work PhoneArea CodePhone NumberMother's Name*PrefixFirst NameLast NameMother's E-mail*Mother's Cell Phone*Area CodePhone NumberMother's Work PhoneArea CodePhone NumberParent's Marital Status*Is the biological mother of the child Jewish?*YesNoWere there any Jewish conversions in your family?*YesNoIf yes, please provide details:Were there any adoptions in your family?*YesNoDoes your family have membership with a Synagogue?*YesNoIf yes, please specify:Emergency Contact Name*PrefixFirst NameLast NameEmergency Contact E-mail*Emergency Contact Cell Phone*Area CodePhone NumberStudent InformationStudent's Full Name*First NameLast NameHebrew Name*Age*Grade*School*Birth Date*1 - January2 - February3 - March4 - April5 - May6 - June7 - July8 - August9 - September10 - October11 - November12 - DecemberMonth12345678910111213141516171819202122232425262728293031Day20232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920YearGender*FemaleMaleHome Phone Number*Area CodePhone NumberAllergy or Health InformationDoes your child's allergies require the use of an Epi Pen?*YesNoDoes your child have any learning or behavioral needs?*YesNoIf yes, please specify.Does your child have a diagnosis?*YesNoIf yes, please specify.Has your child attended Hebrew School in the past?*YesNoDoes your child read basic Hebrew?*YesNoIf yes, how well?WellFairPoorProgram Options:*Monday @ Faywood (3:15-5:30))Tuesday @ Wilmington (3:45-5:45)Tuesday @ CH Best (3:45-5:45)Wednesday @ Dublin (3:30-5:30)Click Here for Bat Mitzvah classesClick Here for Bar Mitzvah classesPlease note that photos taken during school may be used for promotional or publicity purposes. Authorizations for Pick-UpOther than Parents# 1 Full NameFirst NameLast NamePhone NumberArea CodePhone NumberRelationship to Child#2 Full NameFirst NameLast NamePhone NumberArea CodePhone NumberRelationship to ChildChild will only be released to individuals listed in this section unless otherwise indicated in writing by parents/guardian. Payment InformationWithdrawal Policy:Hebrew School tuition includes a $100/session registration fee. The registration fee is non-refundable.The remainder of the tuition fee (excluding the registration fee) is refundable to those who withdraw from the program 6 weeks time or more prior to the start date of the session. During the 6 week window prior to the start date of the session, 50% of the remainder of the tuition fee (excluding the registration fee) is refundable.Once the program begins - there are no refunds . A tax deductible donation receipt will be issued for the full amount.Please note: There are no refunds or make-up classes for illness or family vacations. Payment$675 - January-May 2023Total$0.00Payment:*Credit CardWe accept Visa, MasterCard, American ExpressCredit Card NumberName on Card1 - January2 - February3 - March4 - April5 - May6 - June7 - July8 - August9 - September10 - October11 - November12 - DecemberExpiration Month2023202420252026202720282029203020312032Expiration YearBilling AddressStreet AddressStreet Address Line 2CityState / ProvincePostal / Zip CodePlease SelectUnited StatesAfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanThe BahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChilePeople's Republic of ChinaRepublic of ChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongoCook IslandsCosta RicaCote d'IvoireCroatiaCubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonThe GambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorthern MarianaNorwayOmanPakistanPalauPanamaPapua New GuineaParaguayPeruPhilippinesPitcairn IslandsPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint BarthelemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSomalilandSouth AfricaSouth OssetiaSpainSri LankaSudanSurinameSvalbardSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTristan da CunhaTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamBritish Virgin IslandsUS Virgin IslandsWallis and FutunaWestern SaharaYemenZambiaZimbabweOtherCountryCommentsShould be Empty: Submit This page uses TLS encryption to keep your data secure.