Hebrew School Registration

How many students are you registering?*

Student Number 1

N1:Full Name*

First Name Last Name

N1:Hebrew Name*

First Name Last Name

N1:Birth Date*

Month Day Year

N1:School*

N1:Previous Jewish Education

N1:Grade entering*

N1:Additional notable Information Please let us know if there are any allergies or other important information we need to be aware of.

Student Number 2

N2: Full Name*

First Name Last Name

N2: Hebrew Name*

First Name Last Name

N2: Birth Date*

Month Day Year

N2: School*

N2: Previews Jewish Education

N2: Grade entering*

N2:Additional notable Information Please let us know if there are any allergies or other important information we need to be aware of.

Student Number 3

N3: Full Name*

First Name Last Name

N3: Hebrew Name*

First Name Last Name

N3: Birth Date*

Month Day Year

N3: School*

N3: Previews Jewish Education

N3: Grade entering*

N3: Additional notable information Please let us know if there are any allergies or other important information we need to be aware of.

Student Number 4

N4: Full Name*

First Name Last Name

N4: Hebrew Name*

First Name Last Name

N4: Birth Date*

Month Day Year

N4: School*

N4: Previews Jewish Education

N4: Grade entering*

N4: Additional notable information Please let us know if there are any allergies or other important information we need to be aware of.

Address*

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

Who is registering?*

Father's Name*

First Name Last Name

Father Jewish by *

BirthChoice

Father's Cell*

Area Code Phone Number

Father's E-mail*

Mother's Name*

First Name Last Name

Mother's Hebrew Name

Mother Jewish by:*

BirthChoice

Mother's Cell*

Area Code Phone Number

Mother's E-mail*

Parents Status*

MarriedDivorcedSingle

Best way to send updates:*

Cell PhoneEmailHandout

I am willing to assist in school activities, please contact me

Emergency Contact 1*

First Name Last Name

Phone Number*

Emergency Contact 2*

First Name Last Name

Phone Number

CONFIDENTIAL: Does your child have any allergies or other medical condition we should be aware of? If yes, please describe them and indicate special precautions or care needed.

I want my child/children to be walked over from FFR*

YesNo

I/we hereby confirm my child’s enrollment in Jewish After School Program-JASP.
I/we represent that I am the custodial parent or legal guardian of the child that I am enrolling and that the information I have provided is true and correct.
As the parent(s) or legal guardian, I/we authorize any adult acting on behalf of JASP to hospitalize or secure treatment for my child.
I/we agree to pay all charges for that care and/or treatment.
It is understood that if time and circumstances reasonably permit, JASP personnel will try, but are not required, to communicate with me/us prior to such treatment.
I/we hereby give permission for my child to attend all field trips and outings sponsored by JASP.
I/we allow JASP to use my child’s picture & videos for promotional purposes.
I/we agree to Jewish After School Program's terms and conditions.
I/we fully understand that this enrollment, as part of my commitment to a long-term Jewish education, is accepted only on the basis of the full year program, and agree to pay the full annual or Monthly fees accordingly.
I/we understand that no refunds or adjustments will be made for absences including, but not limited to, illness or vacation.

By clicking you agree and confirm to the above*

Yes, I/we agree and confirm

Registration is complete only by a non-refundable $100 registration fee per child registered. This fee will be deducted from tuition.

Tuition fees are $1200 yearly.
A 20% discount will be applied to all registrations received before July, 31st.
A 10% sibling discount will be applied to families registering multiple children.

How do you want to pay?*

Full Price4 installmentsMonthly

How do you want to pay (2 Kids)?*

Full Price4 installmentsMonthly

How do you want to pay (3 Kids)?*

Full Price4 installmentsMonthly

How do you want to pay (4 kids)?*

Full Price4 installmentsMonthly

Total

$0.00

Payment

Credit Card Paypal Other

Postal / Zip Code

Country

I would like to receive news and updates by email

Registration

Student Information

Student Number 1

Student Number 2

Student Number 3

Student Number 4

Parents Information

Medical Information

Walking Request

Program Agreement

Payment Agreement