Student Information

*Last Name

*First Name

Hebrew Name

*Gender

*Date of Birth

*Address

*City

*State

*Zip

Country

*Home Phone

*Current School

*Grade of Student for 2018-19 School Year. (Please type EC1, EC2, EC3, PreK, K, or 1 - 8)

Note

Medical Information - There will be space to write additional information on a second form after you press the submit button.

*Physician Name

*Physician Phone

*Allergies - Type N/A if none

Parent Information
Father

Title

First Name

Last Name

Work Phone

Cell Phone

Email

Mother

Title

First Name

Last Name

Work Phone

Cell Phone

Email

*Marital Status

*Affiliation

Have there been adoptions or conversions in the family?

If yes, please explain

Emergency Information - I hereby authorize TDS to allow my child to leave TDS ONLY with the following persons. I allow TDS to contact the following persons in the event of an emergency if I cannot be reached.

Name Phone # Relation

*Emergency 1

*Emergency 2

*Emergency 3

Enrollment Options / Tuition & Fees

Please choose enrollment options. Tuition estimates shown are in addition to the mandatory $517.50 registration fee. If applying for scholarship, office will contact you to finalize your tuition cost.

Sessions




Grade Entering

Total Amount:

These are estimated tuition costs. Registration is not complete until registration fee is paid and tuition arrangements made. Please pay mandatory registration fee by credit card below or send in your check / cash registration payment to the office to complete registration.

Payment Information

Please submit credit card or select check / cash below and bring payment to the office. Only registration fee will be charged at this time. If applying for scholarship, office will contact you to finalize your tuition cost.

Charging Registration Fee Only

Select Credit Card or Check / Cash

Card Number

Expiration Date

Security Code

Use Information above

Name on Card

Billing Address

Billing Zip code

I agree to the terms and conditions above

secure