CONGREGATION SHAAREY ISRAEL HEBREW SCHOOL APPLICATION 2011-2012

Student: Please fill out one application per child

Full Name___________________________________________________________________________

Hebrew Name_______________________________________________________________________

Home Address_______________________________________________________________________

Home Phone #_______________________________________________________________________

Birth Date_____________ ______ Gender (M/F)_____Grade as of 9/2011_____

Parent’s Address if different______________________________________Father____Mother____

Mother’s Home #____________Work#_____________Cell #______________Email Address_________

Father’s Home #____________ Work#_____________Cell #______________Email Address__________

Hebrew School Tuition for Grades K-7 Per Child

GRADES MEMBER FEES NON-MEMBER FEES

Kindergarten-2^nd                              Free                                                                                                                           $150                                                 

Grades 3-7                                                           $600                                                                                                                          Not Available

*Grades 3-7 (New)                      $300             

Families with children in Grades 3-7 must be members of Congregation Shaarey Israel.

*New Family Members receive a 50% tuition discount for the first two years in the Hebrew School.

TUITION PAYMENT MUST ACCOMPANY THIS APPLICATION

HEBREW SCHOOL SCHEDULE

GRADE DAY OF WEEK TIME

Kindergarten-2^nd Grade                                   TUESDAY                                                                  4:15-5:45 PM

GRADES 3-7                                                                                          MON. & WED                                              4:30-6:30 PM           

Pertinent Information: (Learning, Health, Behavioral Issues/Special Living Arrangements

_______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

My child has the following allergies________________________________________________________

My child takes the following medications___________________________________________________

Parent/Gurardian Signature: Date: