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Registration Form

Registration Form



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We are currently accepting application forms for the 2016-2017  school year. Please fill out ALL fields of this form. If you have any questions or concerns you'd like to discuss with us, please contact us. We will not be accepting credit card payments this year. Please pay by check. All checks can be made out to Jewish Center of Northern Liberties, and mailed to

T he Jewish Center of Northern Liberties
800 N 2nd St. #120
Philadelphia, PA 19123

We look forward to a wonderful year of learning and growth.

Student Profile
 
* Name
* Last
* Hebrew Name
* DOB
* School
* Grade
* Hebrew Reading Proficiency None Somewhat Well
* Previous Jewish Education Yes No
* Where?
2nd Child Profile
 
Name
Last
Hebrew Name
DOB
School
Grade
Hebrew Reading Proficiency None Somewhat Well
Previous Jewish Education Yes No
Where?
3rd Child Profile
 
Name
Last
Hebrew Name
DOB
School
Grade
Hebrew Reading Proficiency None Somewhat Well
Previous Jewish Education Yes No
Where?

Parent Information
 
* Father's Name
* Phone
* Mother's Name
* Is the natural mother Jewish? Yes No
* Are there any conversions on the mothers side? Yes No
* Phone
* Address
* City
* State
* Zip
* Email Address

Emergency Information
 
* Emergency Contact 1
* Phone
* Emergency Contact 2
* Phone

CONFIDENTIAL: Does your child have any allergies or other medical condition we should be aware of? If yes, please describe them and indicate special precautions or care needed.




As the parent(s) or legal guardian of the above child, I/we authorize any adult acting on behalf of The Hebrew School 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, Chabad Hebrew School 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 trips on and beyond school properties and allow my child to be photographed while participating in Chabad Hebrew School activities and that these pictures may be used for marketing purposes.

I Accept

Name:
Date:

PAYMENT SCHEDULE & OPTIONS

Tuition for school year 2016-2017

Child

2nd Child

3rd Child

Sunday Morning

$550

$500($50 sibling discount)

$500 ($50sibling discount)

 

                        
       

 

*If you are in need of a scholarship, please contact us. We are happy to help.

These fees are ALL inclusive there will be NO OTHER CHARGES for supplies, snacks etc.

I Will be sending in payment by check to
The Hebrew School
c/o The Jewish Center of Northern Liberties
800 N. 2nd St. Suite 120
Philadelphia, PA 19123



We look forward to a wonderful year of learning and growth!

 

 

 

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