Student Information
*First Name
*Last Name
Hebrew Name
*Date of Birth
*Postal Code
*Home Phone
*Grade entering
Notes: Allergies/Learning Challenges/Disabilities
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

$50 Non refundable Registration & Book fee will be charged now. Tuition Fee is $800 minus Discounts and does not include the registration fee. Tuition fee can be charged either in one payment on September 1 ($10 discount) or in four payments on the first of September, October, November, & December. For alternative payment plans kindly contact

All Sessions

*Payment Options
Total Amount:

A $50 discount will be applied to the Tuition Fees for Registrations submitted by Friday June 30th. A $25 sibling discount and a $25 referral discount is also available. Please note referrals in the comment section above.

Payment Information
Only registration fee ($50) will be charged at this time.
Registration Fee: $50
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