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Registration

PAYMENT INFORMATION
•Tuition for Sept 2019-June 2020 is $875 * 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.
Location*
Dublin Heights (Wednesdays 3:00-5:00pm)Faywood ABC (Mondays 3:15-5:15pm)Wilmington (Tuesdays 3:15-5:15pm)
Student Information
Student's Full Name*
First NameLast Name

Home Address*

Hebrew Name*
Home Phone Number*
Area CodePhone Number
Gender*
FemaleMale
Birth Date*
MonthDayYear
Allergy or Health Information
Does your child's allergies require the use of an Epi Pen?
YesNo
Does your child have any learning or behavioral challenges?
YesNo
If yes, please specify.
Age (as of Sep 1, 2019)*
Grade (as of Sep 1, 2019):*
Has your child attended Hebrew School in the past?*
YesNo
Does your child read basic Hebrew?*
YesNo
If Yes, How well?
Hebrew Immersion option for Grades 3-6(only available at Dublin and Faywood)
YesNo
Would you be interested in a Bar/Bat Mitzvah Program outside of regular programming?
YesNo
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 biological 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:
Authorizations for Pick-Up
Other than Parents
# 1 Full Name
First NameLast Name
Phone Number
Area CodePhone Number

Address

Address

Relationship to Child*
Child will not be released to any individual not in this section unless otherwise indicated in writing by parents/guardian.
Payment Information
Hebrew School Fee*
$875

Payment

Credit Card

Billing Address

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Country

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Student Information