Hebrew School Registration 2021-2022 - Form

* Parent 1 First Name

* Parent 1 Last Name

* Parent 1 Relationship to Child

* Parent 1 Email

* Parent 1 Religion

Parent 1 Occupation

* Parent 1 Mobile Phone

* Parent 1 Address

* Parent 1 City

* Parent 1 Postal Code

Parent 2 First Name

Parent 2 Last Name

Parent 2 Relationship to Child

Parent 2 Email

Parent 2 Mobile Phone

Parent 2 Occupation

Parent 2 Religion

Parent 2 Address (if different from Parent 1)

* Emergency Contact First Name (non-parent)

* Emergency Contact Last Name

* Emergency Contact Relationship to Student

* Emergency Contact Mobile Phone

Are you a member of Beth Radom?

Members in good standing receive a 10% discount on tuition. Please enter the discount code MEMBER on the payment page to receive your discount.

How Many Children Are You Registering?

* Child 1 First Name

* Child 1 Last Name

* Child 1 Pronouns

* Child 1 Grade in Sept 2021

Child 1 Birthday

* Child 1 Hebrew Name

* Child 1 School

Child 1 Living Arrangements

Child 1 Medical Information: Does your child have special medical needs, including allergies? Please describe below.

Child 1 Educational Information: Does your child have special learning or behaviour needs? Please describe below. We do our best to offer accommodations and support and would appreciate as much information as is possible.

Child 1 Choice of Program

* Child 1 Program Selection

Please Select OneSK-Grade 3: In-Person Hebrew School only: $600PreK-Grade 3: Virtual Hebrew School only: $600Grade 4-6: In-Person Hebrew School & Private Hebrew Tutorials: $1200Grade 4-6: Virtual Hebrew School & Private Hebrew Tutorials: $1200Bar/Bat Mitzvah Full Program: In-Person Hebrew School & Private Bar/Bat Mitzvah lessons: $1800Bar/Bat Mitzvah Full Program: Virtual Hebrew School & Private Bar/Bat Mitzvah lessons: $1800Bar/Bat Mitzvah Hebrew Proficiency Lessons: $360

Tax receipts are issued. Payments may be split into installments at payment page.

* Child 2 First Name

* Child 2 Last Name

* Child 2 Pronouns

* Child 2 Grade in Sept 2021

* Child 2 Birthday

* Child 2 Hebrew Name

* Child 2 School

Child 2 Living Arrangements

Child 2 Medical Information: Does your child have special medical needs, including allergies? Please describe below.

Child 2 Educational Information: Does your child have special learning or behaviour needs? Please describe below. We do our best to offer accommodations and support and would appreciate as much information as is possible.

Child 2 Choice of Program

* Child 2 Program Selection

Tax receipts are issued. Payments may be split into installments at payment page.

* Child 3 First Name

* Child 3 Last Name

* Child 3 Pronouns

* Child 3 Grade in Sept 2021

* Child 3 Birthday

* Child 3 Hebrew Name

* Child 3 School

Child 3 Living Arrangements

Child 3 Medical Information: Does your child have special medical needs, including allergies? Please describe below.

Child 3 Educational Information: Does your child have special learning or behaviour needs? Please describe below. We do our best to offer accommodations and support and would appreciate as much information as is possible.

Child 3 Choice of Program

* Child 3 Program Selection

Tax receipts are issued. Payments may be split into installments at payment page.

* Child 4 First Name

* Child 4 Last Name

* Child 4 Pronouns

* Child 4 Grade in Sept 2021

* Child 4 Birthday

* Child 4 Hebrew Name

* Child 4 School

Child 4 Living Arrangements

Child 4 Medical Information: Does your child have special medical needs, including allergies? Please describe below.

Child 4 Educational Information: Does your child have special learning or behaviour needs? Please describe below. We do our best to offer accommodations and support and would appreciate as much information as is possible.

Child 4 Choice of Program

* Child 4 Program Selection

Tax receipts are issued. Payments may be split into installments at payment page.

Total Owing:

Online payment required in order to complete registration.

By submitting this form, we agree to the following:

1. Parent Supervision: It is expected that a responsible adult will be present during all tutorial sessions, whether online or in person.

2. Cancellation Policy: After September 1, 2021, tuition is completely non-refundable and considered a charitable donation. Up to August 31, 2021 tuition will be refunded in full, less a $100 administrative fee.

3. Emergency Situations: If we or our emergency contact cannot be reached in the event of a medical emergency, we hereby give permission to the physician or hospital selected by the school or its selected representative, to hospitalize and/or secure proper treatment for our child(ren) named above. We understand that any costs incurred will be our responsibility.

4. We understand that any costs incurred by damage to the school property by our child(ren) will be our responsibility.

5. From time to time, limited information about your child(ren) may be disclosed beyond the scope of Beth Radom Congregation. This may include the release of students’ images, artwork, writing or other school related work to the media for publicity, displays, newsletters, etc. If you do not consent to the release of information, please inform Julie Sermer in writing prior to the commencement of the school year. (As of September 2021)

* Form Completed By

* Date