Register

Student Information:
Full Name:*
First Name Last Name
Hebrew Name:
Birth Date*

Month Day Year
What time was your child born? (So we can calculate their Hebrew Birthday)*
Hour Minutes
Child's Gender:*

BoyGirl
School Currently Attending:
Grade entering in September 2023*
Hebrew reading proficiency:

NoneSomewhatWell
Parent Information:
Mother's Name:
Mother's Mobile Phone Number:

Area Code Phone Number
Mother's Work Phone Number:

Area Code Phone Number
Occupation:
Mother's E-mail:
Father's Name:
Father's Mobile Phone Number:

Area Code Phone Number
Father's Work Phone Number:

Area Code Phone Number
Occupation:
Father's E-mail:
Is biological mother of the child Jewish by birth?*

YesNo
Were there any conversions or adoptions in your family?*

YesNo
If one parent is living separately please specify:
Home Phone Number:

Area Code Phone Number
Home Phone Number #2:

Area Code Phone Number

Child's Primary Address*

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Emergency Information:
In an emergency please first contact :*

MotherFather
Emergency Contact (not living with you):*
Relation: *
Home Phone Number:*

Area Code Phone Number
Work Phone Number:*

Area Code Phone Number
Mobile Phone Number:*

Area Code Phone Number
Emergency Contact #2 (not living with you):*
Relation:*
Home Phone Number:*

Area Code Phone Number
Work Phone Number:*

Area Code Phone Number
Mobile Phone Number:*

Area Code Phone Number
Doctor's Name:*
Doctor's Phone Number:*

Area Code Phone Number

Doctor's Address*

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Allergies or other Medical Conditions:* If any, please explain:
Up to date with vaccinations?*

YesNo
How did you hear about us?
Are you interested in educational programs for adults?

YesNo
Agreements & Payment
Tuition Agreement:

The following is the tuition agreement for the Hebrew School of the Arts. The agreement explains the tuition fees, payments plans and refund policies. Please read it through carefully. If paying by check or cash, full payment must be submitted to the school office before any child will be permitted to attend classes.

The tuition for the Hebrew School of the Arts is $675.00 per year per child. (Scholarships are available upon request. No child will be turned away for inability to pay)

Disclaimer:

In the event of a child withdrawing from school before the end of the school year, refunds will be pro-rated up to January 1 provided that the school office is given 30 days written notice. Tuition refunds will not be granted to children withdrawing from school after Jan 1st.

There are no refunds or credits for days missed due to illness, holidays, or family vacations.
You may choose from the following payment methods:*

Option 1: Pay in full via credit card ($675).Option 2: You will be billed nine payments of $75 (totaling $675) via your credit card.Option 3: Pay in full via check or cash (see above).
Parental Authorization:

As the parent(s) or legal guardian, I/we authorize any adult acting on behalf of ACHS to hospitalize or secure treatment for my child, I further agree to pay all charges for that care and/or treatment. It is understood that if time and circumstances reasonably permit ACHS personnel will try, but are not required, to communicate with me prior to such treatment. I hereby give permission for my child to participate in all school activities, join in class and school trip on and beyond school properties and allow my child to be photographed while participating in ACHS activities.
Total

$0.00

Payment

Credit Card Check or Cash.

Postal / Zip Code

Country

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Educate Your Child... Educate a Generation

Student Information:

Parent Information:

Emergency Information:

Agreements & Payment