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The Village Shul Hebrew School 2024-25 Application Form
Please verify reCaptcha before submitting the form.
PARENT INFORMATION
*
First Name
*
Last Name
*
Email
*
Cell Phone #
How would you like to arrange your school fees?
Please Select One
Pay in Full Now
Place a $100.00 Deposit only at this time
Which program are you registering for?
Please Select One
Wednesdays (JK - Grade 6 Program) $1,000.00
Sundays (JK-Grade 6 Program) $1,000.00
Which program are you registering for?
Please Select One
Wednesdays (JK - Grade 6 Program) $1,000.00
Sundays (JK - Grade 6 Program) $1,000.00
*
Child's Family Name
*
Child's First Name
Child's Hebrew Name
*
Child's Date of Birth
*
Public School attending:
*
Grade Entering:
*
Previous Hebrew School Experience:
Was the child:
Please Select One
Born Jewish
Converted
Adopted
Was the child's mother:
Please Select One
Born Jewish
Converted
Adopted
Language spoken at home:
Are you a member of a Synagogue?
Please Select One
Yes
No
Name of Synagogue:
*
Does your child have any allergies
Please Select One
Yes
No
Please select all allergies
Peanuts
Treenuts
Milk
Eggs
Soy
Wheat
Fish
Other Allergies:
*
Does your child have any special medical, or diet information/requirements.
Please Select One
Yes
No
Please provide all medical and/or diet details here.
Epipen carried?
Please Select One
Yes
No
Family Physician & phone number
Does your child have an IEP or any learning issues?
Please Select One
Yes
No
*
Details:
*
How many Adults are on this account
Please Select One
One Adult
Two Adults
*
Adult 1 - First Name
*
Adult 1 - Last Name
*
Adult 1 - Cell Phone
Adult 1 - Work Phone
*
Adult 1 - Email Address
*
Home Address
*
Home City
*
Home Postal Code
*
Adult 2 - First Name
*
Adult 2 - Last Name
*
Adult 2 - Cell Phone
Adult 2 - Work Phone
*
Adult 2 - Email Address
*
Does Adult 2 live at the same address?
Please Select One
Yes
No
Adult 2 - Home Address
Adult 2 - Home City
Adult 2 - Home Postal Code
*
Marital Status
Please Select One
Married
Single
Divorced
Separated
Common Law
Other please explain below
Other
Please list an emergency contact in case Parents cannot be reached.
*
First Name
*
Last Name
*
Relationship to Child
*
Email
*
Cell Phone
*
Address
*
City
Postal Code
$100 deposit or full payment is due upon submission of this form, payable online via credit card. Your payment must be paid in full.
Fees are determined on an academic year basis and take into account the length of the school months and the number of holidays or other days off during the school year.
The balance of tuition may be made paid in up to four (4) installments.
A charitable receipt will be issued for all fees paid.
I have read, understood, and agree to the abo
.
ve conditions of enrollment and confirm the truth and accuracy of all information provided in this application form.
*
Parent #1 Name
*
Date
*
Parent #2 Name
*
Date
Total
Mon, December 30 2024 29 Kislev 5785
