2023-24 Continuous Enrollment Opt Out Form

Continuous Enrollment Opt Out Form

Continuous Enrollment Anniversary is February 24, 2023, for the 2023-24 school year!
Complete this form only if your students will NOT be returning for the 2023-24 school year!

If your students are graduating in May 2023 or returning for the 2023-24 school year DO NOT complete this form!

If you have any questions about Continuous Enrollment or Opting Out, please click here to view HBHA's Opt-Out Withdrawal Policy or contact, Director of Admissions, Tamara Lawson Schuster at tschuster@hbha.edu.

Opt out forms must be submitted electronically!
Parent/Guardian Name *

First NameLast Name
Email
example@example.com
How many student(s) are you withdrawing from HBHA Continuous Enrollment Contract?*
Student Name*

First NameLast Name
2023-24 Grade*
Reason for Opting Out

Please explain reason for withdrawing from HBHA.
Select primary reason for withdrawing student (select 1 option only):*

Personal FinancesRelocating 50 Miles or more from HBHAAcademic ConcernsPersonal/Family ConcernsSocial & Emotional ConcernsReligious Observance (need single gender education)School requested
If other, please explain:
Student Name (2)

First NameLast Name
2023-24 Grade
Reason for Opting Out

Please explain reason for withdrawing from HBHA.
Select primary reason for withdrawing student (select 1 option only):

Personal FinancesRelocating 50 Miles or more from HBHAAcademic ConcernsPersonal/Family ConcernsSocial & Emotional ConcernsReligious Observance (need single gender education)School requested
If other, please explain:
Student Name (3)

First NameLast Name
2023-24 Grade
Reason for Opting Out

Please explain reason for withdrawing from HBHA.
Select primary reason for withdrawing student (select 1 option only):

Personal FinancesRelocating 50 Miles or more from HBHAAcademic ConcernsPersonal/Family ConcernsSocial & Emotional ConcernsReligious Observance (need single gender education)School requested
If other, please explain:
Student Name (4)

First NameLast Name
2023-24 Grade
Reason for Opting Out

Please explain reason for withdrawing from HBHA.
Select primary reason for withdrawing student (select 1 option only):

Personal FinancesRelocating 50 Miles or more from HBHAAcademic ConcernsPersonal/Family ConcernsSocial & Emotional ConcernsReligious Observance (need single gender education)School requested
If other, please explain:
Student Name (5)

First NameLast Name
2023-24 Grade
Reason for Opting Out

Please explain reason for withdrawing from HBHA.
Select primary reason for withdrawing student (select 1 option only):

Personal FinancesRelocating 50 Miles or more from HBHAAcademic ConcernsPersonal/Family ConcernsSocial & Emotional ConcernsReligious Observance (need single gender education)School requested
If other, please explain:
Student Name (6)

First NameLast Name
2023-24 Grade
Reason for Opting Out

Please explain reason for withdrawing from HBHA.
Select primary reason for withdrawing student (select 1 option only):

Personal FinancesRelocating 50 Miles or more from HBHAAcademic ConcernsPersonal/Family ConcernsSocial & Emotional ConcernsReligious Observance (need single gender education)School requested
If other, please explain:
Note: Your reason for opting out will not affect your ability to withdraw your child(ren) from HBHA. This is for data collection purposes only.

By opting out of HBHA Continuous Enrollment for the 2023-24 school year, I am aware that my child(ren) will not be enrolled at HBHA for the coming school year, or subsequent school years. Submitting this form does not prevent me/we from enrolling our student(s) at HBHA in future school years. I/we have read and understand HBHA's policies for withdrawing my student(s) and Opting Out of my Continuous Enrollment Agreement with Hyman Brand Hebrew Academy.
My electronic signature below is the same as my handwritten signatures for the purposes of validity, enforceability, and admissibility. *

Clear
Today's Date*
If you have any questions or concerns, please contact the Director of Admissions, Tamara Lawson Schuster:

Phone: 913-327-8135

Email: tschuster@hbha.edu
Should be Empty:

Continuous Enrollment Opt Out Form

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Reason for Opting Out

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