Weston/Westport Hebrew School Registration Form

Hebrew School Registration Form

Tuition payment deposit of $350 must be submitted with this form. Annual tuition is $1,450 per child. (payment options below). Register by July 1, for Earlybird tuition discount of $1,350
Full Name

First NameLast Name
Hebrew Name
Birth Date

MonthDayYear
Time of Birth

:HourMinutesAM/PM Option
Grade
Age
School
Clubs are incorporated in the Hebrew School Program (for 6-7th graders)
T-Shirt Size (child's)
Second Child
Full Name

First NameLast Name
Hebrew Name
Birth Date

MonthDayYear
Time of Birth

:HourMinutesAM/PM Option
Grade
Age
School
T-Shirt Size (child's)
Third Child
Full Name

First NameLast Name
Hebrew Name
Birth Date

MonthDayYear
Time of Birth

:HourMinutesAM/PM Option
Grade
Age
School
T-Shirt Size (child's)
Home Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone Number

Area CodePhone Number
Parent Information
Mother's name

First NameLast Name
Hebrew Name
Cell Phone

Area CodePhone Number
Work Phone

Area CodePhone Number
E-mail
Father's Name

First NameLast Name
Hebrew Name
Cell Phone

Area CodePhone Number
Work Phone

Area CodePhone Number
E-mail
Is the child’s natural mother Jewish?
If there were any adoptions or conversions in the family please explain.
Medical and Emergency Information
Known allergies or medical/nutritional sensitivities?
If parents cannot be reached in case of an emergency or illness, contact:
Name

First NameLast Name
Phone Number

Area CodePhone Number
Relationship to child:
Permission Agreement and Waiver
I hereby allow you to photograph/video my child/ren and use it for publicity or other projects.
I hereby permit my child to participate in all School activities and to join in class and school trips on and beyond school properties and use any transportation selected by the Weston/Westport Hebrew School.
Initial Here
I give permission to the staff of Weston/Westport Hebrew School to take whatever emergency (i.e., first aid, disaster evacuation) measures as judged necessary for the care and protection of my child while under the supervision of Weston/Westport Hebrew School.
Initial Here
I hereby give my permission to the physician selected by Weston/Westport Hebrew School to hospitalize and/or secure necessary treatment or anesthesia for my child, as named above in the event that I cannot be reached in an emergency. In case of medical emergency requiring immediate emergency care, I authorize the first responders to take my child to the nearest hospital, if necessary.
Initial Here
Parent/ Guardian
Print your name
Date

MonthDayYear
Parent/Guardian Signature

Sign Here
Tuition Contract & Payment

Additional students will receive a Sibling Discount of $10% off their $1450 Tuition. Tuition fees are non-refundable. Should you decide to withdraw your child from WHS, your refund will be pro-rated up to January 1. After that date no refund will be allowed for WHS tuition. There are no refunds or credits for days missed due to illness, holidays, or family vacations. *Bar/Bat Mitzvah tutoring & preparation are not included in school tuition. No child will be turned away due to financial difficulty. We believe that every child deserves a Jewish education. Please reach out to our office to discuss scholarship options.
Tuition Tuesdays
We might offer a Sunday option 10:00am - 11:30am. If interested, Check the box below.
I hereby agree to pay tuition in the amount of $1,450 per child (non-refundable)
Sign Here
I hereby agree to pay tuition in the amount of $1,450 per child (non-refundable)*

Sign Here
Payment options:
Please charge my card monthly in the amount of $
$ ( last payment in March)
Philanthropic Leadership Circle. I would like to contribute to the Hebrew School scholarship fund in the amount of $
$ Donation (tax deductible)

Please Charge my card now in the amount of

USD$ Tuition/Donation

Debit or Credit Card
First Name	Last Name
Credit Card Number	Security Code
Expiration Month	Expiration Year

Should be Empty:

Hebrew School Registration Form

Second Child

Third Child

Parent Information

Medical and Emergency Information

Permission Agreement and Waiver

Tuition Contract & Payment

Please Charge my card now in the amount of*

Please Charge my card now in the amount of