Registration

Hebrew School Registration 2023/2024
CHILD'S INFO:
Full Name*

First Name Last Name
Hebrew Name
Gender*

MaleFemale
Birth Date*

Month Day Year
Time of Birth

Hour Minutes
School Attending* 2023/2024
Grade* 2023/2024
Past Hebrew Lessons*

No Previous HSPrivate Tutor
Please choose a program:*

Grades K-2: Sunday morningGrades 3-6: Sunday morningGrade 7: Sunday morning + 2 evenings a month
Register another child?

YesNo
CHILD 2:
Full Name

First Name Last Name
Hebrew Name
Gender

MaleFemale
Birth Date

Month Day Year
Time of Birth

Hour Minutes
School Attending 2023/2024
Grade 2023/2024
Past Hebrew Lessons

No Previous HSPrivate Tutor
Please choose a program:*

Grades K-2: Sunday morningGrades 3-6: Sunday morningGrade 7: Sunday morning + 2 evenings a month
Parents
Parent's Marital Status*
Child lives with*
Is the natural mother of the child Jewish?*

YesNo
Have their been any conversions or adoptions in the family?*

YesNo
If yes, please specify Rabbi & Congregation
PARENT 1:
Parent 1 Title*
Parent 1 Full Name*

First Name Last Name
E-mail*
Work Phone*

Area Code Phone Number
Cell Phone*

Area Code Phone Number
Occupation*
PARENT 2:
Parent 2 Title
Parent 2 Full Name

First Name Last Name
E-mail
Work Phone

Area Code Phone Number
Cell Phone

Area Code Phone Number
Occupation
HOME:

Home Address*

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

Home Phone

Area Code Phone Number
Emergency Contact Information
EMERGENCY CONTACT:
Full Name*

First Name Last Name
Phone Number*

Area Code Phone Number
Relation*
MEDICAL AND SPECIAL NEEDS:
Is your child taking permanent medications?*

YesNo
Any known allergies (incl. reactions to medications)?*

YesNo
Any present medical conditions?*

YesNo
Any learning disabilities?*

YesNo
If you answered yes to any of the questions above, please provide details:
PHYSICIAN:
Family Physician*
Phone Number*

Area Code Phone Number
Address*
General Information
OTHER PERSON AUTHORIZED TO PICK UP CHILD:
Name of Authorized Person

First Name Last Name
Cell Phone of Authorized Person

Area Code Phone Number
Relationship of Authorized Person
TRIPS:

I give permission for my child to participate on class trips throughout the school year:
Trips Permission:*

YesNo
Tuition and Billing
K-2nd Grade

Member $250 and 7 Payments of 92.86 =$900

Non member $250 and 7 Payments of 128.57 =$1,150

3rd - 6th Grade

Member $250 and 7 Payments of 107.15 =$1000

Non member $250 and 7 Payments of 142.85 =$1250

CTeen Jr. (7th Grade)

Member $250 and 7 Payments of 135.72 =$1200

Non member $250 and 7 Payments of 200.00 =$1650
PROGRAM & TUITION AGREEMENT:

I hereby confirm my child’s enrollment in The Chai Center Noskin Hebrew School.

I 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.

I fully understand that this enrollment, as part of my commitment to a long-term Jewish education at Noskin Hebrew School, is accepted only on the basis of the full year program, and agree to pay the full annual fees accordingly. I understand that no refunds or adjustments will be made for absences including, but not limited to, illness or vacation.

I agree to the following Mandatory Fees, due at registration:

$54 Student Activity Fee per family
$100 Security Fee per family
Signature of Parent or Legal Guardian*
Date*

Month Day Year
PAYMENT OPTIONS:
Membership Status*

Chai Center MemberNon Member
Payment Plan*

PLAN A: Pay the entire amount in full, including fees, at time of registrationPLAN B: Pay $250 non-refundable registration fee (towards tuition fee), Plus Mandatory Program Fees Today, Plus monthly payements*
* 7 Automatic monthly credit card payments on the 1st of the months: September through March

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

Disclaimer
Accident: As the parent(s) or legal guardian of the above child/ren, I/we authorize any adult acting on behalf of Noskin Hebrew School 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, Noskin Hebrew School personnel will try, but are not required, to communicate with me prior to such treatment.

Trips and Outings: I hereby give permission for my child to attend and participate in all trips and outings organised as part of the program by The Chai Center Noskin Hebrew School.

Privacy: I hereby give permission for my child’s photographs/videos to be used in newsletters, local newspapers, The Chai Center and Noskin Hebrew School website or for promotion of our program.
Digital Signature of Parent or Legal Guardian*
Date*

Month Day Year
Should be Empty:

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Hebrew School Registration 2023/2024

Parents

Emergency Contact Information

General Information

Tuition and Billing

Disclaimer