Registration 2024-2025

*

New studentRe-enrollment
Parents Information
Mother's Name*

First Name Last Name
Mother's Hebrew Name

First Name Last Name
Mother's Mobile*
Mother's E-mail*
Father's Name*

First Name Last Name
Father's Hebrew Name

First Name Last Name
Father's Mobile*
Father's Email*
Is the natural mother of the child Jewish?*

YesNo
Is the natural father of the child Jewish?*

YesNo
If applicable, please describe any conversions or adoptions in your family* Put 'N/A' if not applicable
Best way to send Hebrew School updates:*

Mobile PhoneEmailHandout
I am willing to assist in school activities, please contact me
Student Information
Will you be paying in Installments?*

YesNo
How many installments?* Prices automatically adjusted upon payment

3 months5 months
How many children are you registering?* Automatic 10% discount applied for 2nd and 3rd child
How many children are you registering?* Automatic 10% discount applied for 2nd and 3rd child
How many children are you registering?* Automatic 10% discount applied for 2nd and 3rd child
First Child
Full Name*

First Name Last Name
Hebrew Name

First Name Last Name
Birth Date*

Month Day Year
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.
Second Child
Full Name*

First Name Last Name
Hebrew Name

First Name Last Name
Birth Date*

Month Day Year
School
Previous Jewish Education
Grade Entering*
Additional notable Information Please let us know if there are any allergies or other important information we need to be aware of.
Third Child
Full Name*

First Name Last Name
Hebrew Name

First Name Last Name
Birth Date*

Month Day Year
School
Previous Jewish Education
Grade Entering*
Additional notable Information Please let us know if there are any allergies or other important information we need to be aware of.
Fourth Child
Full Name*

First Name Last Name
Hebrew Name

First Name Last Name
Birth Date*

Month Day Year
School
Previous Jewish Education
Grade Entering*
Additional notable Information Please let us know if there are any allergies or other important information we need to be aware of.
Emergency Information
Emergency Contact*

First Name Last Name
Relationship to child*
Phone Number*

Area Code Phone Number
Doctor's Name

First Name Last Name
Doctor's Telephone

Area Code Phone Number

Doctor's Address

Address

Accident, Privacy & Field Trip Declaration
Accident: As the parent(s) or legal guardian of [child(ren) listed], I/we authorize any adult acting on behalf of Danville Hebrew to hospitalize or secure treatment for my child, I further agree to pay all charges for that care and/or treatment. It is understood that if time and circumstances reasonably permit, Danville Hebrew personnel will try, but are not required to communicate with me prior to such treatment.

Trips & Outings: I hereby give permission for my child to attend and participate in all trips and outings organized as part of the program by Danville Hebrew.

Privacy: I hereby give permission for my child’s photographs/videos to be used for educational or promotional purposes, which include but are not limited to, brochures, Danville Hebrew website and Danville Hebrew social media. I understand that I can withdraw my consent at any time.
Signature of parent or legal guardian: * Kindly write your full name
Date Signed

Month Day Year
Additional Comments
Payment
EARLY BIRD SPECIAL until May 31st: $895

PRICE AFTER MAY 31st: $995

Referral Discount: $50

Sibling Discount: 10%

For scholarship application please email [email protected]

No one will be turned away due to lack of funds.
Total:

$0.00