Chaya Esther Hebrew School Application 2018-2019/5779

* Application Type

* Partnership Status

* Number of Children Applying

* Child 1 Full Name

Child 1 Jewish Name

Please Select OneMaleFemale

* Date Of Birth

* Grade Entering Sept. 2018

* Child 2 Full Name

Child 2 Jewish Name

Please Select OneMaleFemale

* Date Of Birth

* Grade Entering Sept. 2018

* Child 3 Full Name

Child 3 Jewish Name

Please Select OneMaleFemale

* Date Of Birth

* Grade Entering Sept. 2018

* Street Address

* City

* State

* Zip Code

Home Phone

Marital Status of Parents

Child lives with

* Father's Full Name

Please Select OneJewishNot Jewish

Father's Jewish Name

* Father's DOB

Father's Work Phone

* Father's Cell

* Father's Email

* Mother's Full Name

Please Select OneJewishNot Jewish

Mother's Jewish Name

* Mother's DOB

Mother's Work Phone

* Mother's Cell

* Mother's Email

Synagogue Affiliation

Day School

* How did you hear about us?

Does your child read or speak Hebrew?

Please Select OneYesNo

Has your child previously attended Hebrew School?

Please Select OneYesNo

Which Hebrew School did they attend?

Does your child have any learning difficulties with general studies?

Please Select OneYesNo

If yes, please describe

* Were there any conversions and/or adoptions in the family?

Please Select OneYesNo

* If yes, who?

Is anyone in the family a Kohen or Levi?

Please Select OneYesNo

If yes, who?

* Does your child have any allergies?

Please Select OneYesNo

* If yes, please describe

Does your child have any special needs, medication, or anything you feel we should know about?

Please Select OneYesNo

If yes, please describe

* Emergency Contact Name

* Relationship to Child

* Phone 1

Phone 2

* Family Physician Name

Phone

Please List Additional Children Not Attending Hebrew School

Please include each Child's Full Name, Jewish Name, and DOB

Please fill in any new or updated information below.

Leave blank if same as last year

Home Phone

Father's Cell

Mother's Cell

Father's Email

Mother's Email

Marital Status of Parents

Child Lives With

Were there any conversions and/or adoptions in the family?

Please Select OneYesNo

If yes, who?

Emergency Contact Name

Relationship to Child

Phone 1

Phone 2

Family Physician Name

Phone

Does your child have any allergies?

Please Select OneYesNo

If yes, please describe

Does your child have any special needs, medication, or anything you feel we should know about?

Please Select OneYesNo

If yes, please describe

Please List Additional Children Not Attending Hebrew School

Please include each Child's Full Name, Jewish Name, and DOB

TUITION:

Tuition is $800 for the year per child, plus a $100 registration fee per child
(includes all books and pizza lunch)

You may choose to pay in full now and receive a 5% discount, or pay just the $100 registration fee now, and split the remaining tuition balance into 4 installments.

There will be no refunds for any payments made.

* Payment Information:

Please Select One$100 registration fee and full payment charged now (5% discount)$100 registration fee charged now and tuition balance charged in 4 installments on the first of September November January & March

* Payment Information:

Partner Discount Applied - 10% off

* Payment Information:

Sibling Discount Applied - $40 off each additional child

* Payment Information:

Partner Discount Applied - 10% off

Sibling Discount Applied - $40 off each additional child

* Credit Card Number For Tuition Installments

This card will be used for your 4 tuition installments (on the first of September, November, January & March).

The $100 registration fee will be charged separately via PayPal on the next screen

* Name on Card

* Expiration Date

* Security Code

* Billing Zip:

Total Charge:

CHAYA ESTHER HEBREW SCHOOL AGREEMENT

Hours: Sunday, 10:00 am – 12:30 pm

Tuition Includes

Pizza lunch and workbooks

Tuition Notices

To register, a completed registration form is necessary along with a $100 registration fee per child
If full payment is not received with registration form, tuition balance will be charged in 4 installments on the first of September, November, January and March
There is no credit for absences or days missed.

Activities

My child has permission to engage in all programmed activities. Additionally, permission is hereby granted to Chaya Esther Hebrew School to take my child on trips outside of school as part of the regular school program.

Images

Permission is hereby granted to Chaya Esther Hebrew School to use digital, photographic, video and audio images and likenesses of my child/ren in promoting Hebrew School and other ventures associated with Center for Jewish Life.

Medical Release

In the event that I cannot be contacted in an emergency or situation warranting medical attention, I hereby grant permission to Chaya Esther Hebrew School to bring my child/ren to the emergency room and/or give permission to the medical personnel selected by the Hebrew School director to provide routine healthcare.

Dismissal of Student

Chaya Esther Hebrew School reserves the right to dismiss any student whose condition, conduct, influence or behavior is deemed unsatisfactory or detrimental to the best interest of the school, the student or their fellow students. In these instances, no refunds will be issued.

* I have read and accepted all terms and conditions set forth on this application.

I have read and accepted all terms and conditions set forth on this application.

* Parent/Guardian Signature

Connect With CJL

Center for Jewish Life • 176 Route 79 North Marlboro, NJ 07746 • Phone: 732-316-7600 • Fax: 732-316-0300 • info@cjlnj.com