HS Registration - 2023/24 School Year

Sunday Mornings 9:15-11:45am
1st Child's Name*

First Name Last Name
1st Child's Hebrew Name* We can help give your child a Hebrew name
1st Child's Birth Date*

Month Day Year
1st Child's School*
1st Child Grade entering* as of September 1, 2021
First Child's E-mail
2nd Child's Name

First Name Last Name
2nd Child's Hebrew Name We can help give your child a Hebrew name
2nd Child's Birth Date

Month Day Year
2nd Child's School
2nd Child Grade entering as of September 1, 2021
2nd Child's E-mail
Additional notable Information Please let us know if there are any allergies or other important information we need to be aware of.
Parents Information
Mother's Name*

First Name Last Name
Mother's Hebrew Name
Mother Jewish by:*

BirthChoice
Mother's Cell*

Area Code Phone Number
Mother's Home or Work

Area Code Phone Number
Mother's E-mail*
Mother's Occupation
Father's Name*

First Name Last Name
Father's Cell*

Area Code Phone Number
Father's Home or Work

Area Code Phone Number
Father's E-mail*
Father's Occupation
Best way to send Hebrew School updates:*

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

Address*

Payment

Credit Card

We accept Visa, MasterCard, American Express, Discover
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

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Parents Information