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Hebrew School Registration

Number of Student/s
Student Information
Full Name*
First Name Last Name
Hebrew Name
First Name Last Name
Birth Date*

Month Day Year
School
Previous Jewish Education
Grade entering*
Additional notable Information Please let us know if there are any allergies or other important information we need to be aware of.
Student #2 Information
Full Name
First Name Last Name
Hebrew Name
First Name Last Name
Birth Date

Month Day Year
Grade entering
Additional notable Information Please let us know if there are any allergies or other important information we need to be aware of.
Student #3 Information
Full Name
First Name Last Name
Hebrew Name
First Name Last Name
Birth Date

Month Day Year
Grade entering
Additional notable Information Please let us know if there are any allergies or other important information we need to be aware of.
Parents Information
Father's Name*
First Name Last Name
Father's Cell

Area Code Phone Number
Mother's Name*
First Name Last Name
Mother's Hebrew Name
Mother Jewish by:*

BirthConversion
Please upload a copy of conversion proof
Mother's Cell*

Area Code Phone Number
I am willing to assist in school activities, please contact me
Payment
Registration Fee

ƒ300.00 ($170) per studentOther
Number of Student/s
Other

Pay in 3 payments of ƒ100 per studentSubsidized Tuition
We will never turn away a Jewish child due to lack of funds.
Total in US$

$0.00
Disclaimer: Florin to USD conversions are approximate.

Payment Method*

Credit Card Other

Postal / Zip Code

Country

Should be Empty:

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