Registration

Parents Information
Father's Name*
First Name Last Name
Father's E-mail*
Father's Cell*

Area Code Phone Number
Mother's Name*
First Name Last Name
Mother's E-mail*
Mother's Cell*

Area Code Phone Number
Parents Marital Status*

MarriedDivorcedSeparated
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 a membership with a synagogue?*

YesNo
If yes, please specify
Emergency Contact Name*
First Name Last Name
Emergency Contact Phone Number*

Area Code Phone Number
Student Information
Full Name*
First Name Last Name
Hebrew Name*
First Name Last Name
Gender*

MaleFemale
Birth Date*

Month Day Year
Age (January 2025)*
Grade (January 2025)*
Allergy/Health Information Please write if your child's allergy requires use of an EpiPen
Does your child have any learning or behavioral needs?*

YesNo
If yes, please specify
Does your child have a diagnosis?*

YesNo
If yes, please specify
Has your child attended Hebrew School in the past?*

YesNo
Were you referred by a current HS family?* If yes, write family name in comments

YesNo
Program Options*

16 Mondays @ Faywood (3:15-5:15)19 Tuesdays @ Wilmington & CH Best (3:00-5:00)19 Wednesdays @ Dublin (3:30-5:30)
Authorizations For Pickup (other than parents) Please include name, phone number, and relationship to child
- Child will only be released to individuals listed in this section unless otherwise indicated in writing by parents/guardian.
Click Here for Bat Mitzvah classes
Click Here for Bar Mitzvah classes
- Please note that photos taken during school may be used for promotional or publicity purposes.
Payment
Withdrawal 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.
Total

$0.00

Payment*

Credit Card

We accept Visa, MasterCard, American Express
Credit Card Number	Security Code
Name on Card
Expiration Month	Expiration Year

Billing Address

Street Address

City

State / Province

Postal / Zip Code

Country

Comments
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● Registration (Alternate Payment)

Educate Your Child... Educate a Generation

Parents Information

Student Information

Payment