Registration

Student Information
Full Name*
First Name Last Name
Hebrew Name*
First Name Last Name
Birth Date*

Month Day Year
Please check all that apply?*

Child was born JewishChild converted to JudaismChild is adoptedMother converted to JudaismFather converted to JudaismMother Jewish by choiceFather Jewish by choice
School*
Previous Jewish Education
Grade entering*

Address*

Additional notable Information Please let us know if there are any allergies or other important information we need to be aware of.
Parents Information
Father's Name*
First Name Last Name
Father's Hebrew Name
Father's Cell*

Area Code Phone Number
Mother's Name*
First Name Last Name
Mother's Hebrew Name
Mother's Cell*

Area Code Phone Number
Communication & Parent Involvement
Best way to send Hebrew School updates:*

Cell PhoneEmailHandout
I am willing to assist in school activities, please contact me
Payment
No one will be turned away for lack of funds.
For payment arrangements, please select "other" and contact Rabbi Levi or Chana Reizes.
Registration Fee* Select $750 for a one time payment or $75 for 10 monthly payments

$750$75
Yes, I'd like to make this a monthly recurring payment.
Total

$0.00

Payment

Credit Card Other

Postal / Zip Code

Country

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