Hebrew School Registration

First child*

Tier 1 $765 per childTier 2 $650 per child

Full Name*

First Name Last Name

Hebrew Name*

Gender*

MaleFemale

Birth Date*

Month Day Year

Time of birth

School*

Grade entering*

Previous Jewish Education

Does your child read basic Hebrew?

YesNo

Does your child have learning difficulties with general studies?

YesNo

Explain

Additional notable Information* Please let us know if there are any allergies or other important information we need to be aware of.

Add second child

Tier 1 $765 per childTier 2 $650 per child

Full Name*

First Name Last Name

Hebrew Name*

Gender*

MaleFemale

Birth Date*

Month Day Year

Time of birth

School*

Grade entering*

Previous Jewish Education

Does your child read basic Hebrew?

YesNo

Does your child have learning difficulties with general studies?

YesNo

Explain

Additional notable Information* Please let us know if there are any allergies or other important information we need to be aware of.

Add third child

Tier 1 $765 per childTier 2 $650 per child

Full Name*

First Name Last Name

Hebrew Name*

First Name Last Name

Gender*

MaleFemale

Birth Date*

Month Day Year

Time of birth

School*

Grade entering*

Previous Jewish Education

Does your child read basic Hebrew?

YesNo

Does your child have learning difficulties with general studies?

YesNo

Explain

Additional notable Information* Please let us know if there are any allergies or other important information we need to be aware of.

Home Address*

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

Mother's Name*

First Name Last Name

Mother's Cell*

Area Code Phone Number

Mother's E-mail*

Mother's Hebrew Name

Mother Jewish by:*

BirthChoiceNot Jewish

Name & Address of Employment

Father's Name*

First Name Last Name

Father's E-mail*

Father's Cell*

Area Code Phone Number

Father's Hebrew Name

Father Jewish by:*

BirthChoiceNot Jewish

Name & Address of Employment

Any Adoptions or conversions in the family (including grandparents)*

YesNo

If yes, please explain

Best way to send Hebrew School updates:*

Cell PhoneMother's EmailFather's Email

I authorize JSA to take my child on school trips. (you will be notified prior to any trips)

I authorize JSA to take pictures/video of my child and use them for publicity purposes (i.e., Brochures, Webs

*

In the event I cannot be reached, I hereby grant permission to the staff of JSA to treat and/or provide a physician or hospital to give emergency treatment to my child

Parent Initial*

Full Name*

First Name Last Name

Phone Number*

Area Code Phone Number

Pediatrician*

Phone Number*

Area Code Phone Number

Please indicate if you'de like to pay all in full or monthly thru December. For scholarships please email [email protected]

Optional Donation to the Pardess Hebrew School Scholarship Fund

$36$50$100

Total

$0.00

I would like to pay today:Full amount20% minimum: $0.00 $

If partial payment is selected, we will charge your card monthly through December, till the full payment is complete.

If you need other payment arrangements, or scholarships, please don't hesitate to call Rabbi Sandhaus at 845-440-7592 or email at [email protected]

Your card is NOT automatically processed when clicking submit. Once the form is submitted we will make the correct calculations or contact you to confirm, before manually charging your card or setting up a monthly charge.

Payment

Credit Card Check

Registration 2024-25

Student Information

Second child Student Information

Third Child Student Information

Parents Information

Emergency Information

Payment