Student Information

*Last Name

*First Name

Hebrew Name


*Date of Birth




*Postal Code

*Home Phone


*Grade entering


Parent Information


First Name

Last Name

Work Phone

Cell Phone




First Name

Last Name

Work Phone

Cell Phone


*Marital Status

*Is Mother Jewish?

If there have been adoptions or conversions in the family, please explain.

Emergency Information

Name Phone # Relation

*Emergency 1

Emergency 2

Emergency 3

Registration / Tuition & Fees

$25 Non refundable Registration & Book fee will be charged now. Tuition Fee is $400 minus Discounts and does not include the registration fee. Tuition fee can be charged either in one payment on November 1 or in three payment on the first of Nov, Dec, and Jan. For alternative payment plans kindly contact


*Payment Options

Total Amount:

A $ 25 discount will be applied to the Tuition Fees for Registrations done before June 15th. A $25 sibling discount and $25 referral discount is also available. Please note referrals in the comment section above.

Payment Information

Only registration fee ($25) will be charged at this time.

Registration Fee: $25

Card Type

*Card Number

*Expiration Date

*Security Code

Use Information above

Name on Card

*Billing Address

*Billing Postal Code

I agree to the terms and conditions above