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)Wilmington (Tuesdays 3:15-5:15pm)

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'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:

Please note that photos taken during school may be used for promotional or publicity purposes.

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

Student Information

Parent Information

Payment Information