This form is for students who were in Hebrew School during the 2019-20 school year. Please use this short form to re-register your child for the 2020-2021 school year! Some fields on this form may not be relevant for this year's special circumstances. Please fill out all applicable fields. If you have any questions or concerns you'd like to discuss with us, please contact us. Full Name* First Name Hebrew Name Last Name Grade* Kindergarten Grade 1 Grade 2 Grade 3 Grade 4 Grade 5 Grade 6 Please choose one of the following options: I will bring my child straight to Hebrew School. I'd like my child to be picked up from Gardenview by Hebrew School staff. Choose from the following exits Please Select B.A.S.E. The Nantel Exit The Stevens Exit What are your goals in terms of your child's Hebrew School education at the Community Hebrew School? Please number each line with numbers 1 to 5. (1=top priority), and add your own to the list. (0=not a priority) Thank you!* Jewish Identity Being in a Jewish environment Hebrew Reading Hebrew Language Socializing with Jewish friends Jewish History Knowledge of Holidays and Traditions Knowledge of Jewish practice/laws/mitzvot Knowledge of Basic Jewish prayers Add your own... Does your child have any learning difficulties? How does your child learn best in a classroom setting?* Have your address / phone numbers / email addresses changed since July 2018? If so, please advise...Thank you!* Payment NEW this year! Refer a new family and get $50 off tuition for your child! Tuition Fees Child 1 - $500 Child 2 - $400 Child 3 - $300 Payment* Credit Card Cash or Check Credit Card Visa MasterCard American Express Credit Card Type Credit Card Number Security Code Name on Card 1 - January 2 - February 3 - March 4 - April 5 - May 6 - June 7 - July 8 - August 9 - September 10 - October 11 - November 12 - December Expiration Month 2020 2021 2022 2023 2024 2025 2026 2027 2028 2029 Expiration Year Billing Address Street Address Street Address Line 2 City State / Province Postal / Zip Code Please Select United States Afghanistan Albania Algeria American Samoa Andorra Angola Anguilla Antigua and Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan The Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bosnia and Herzegovina Botswana Brazil Brunei Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Chile People's Republic of China Republic of China Christmas Island Cocos (Keeling) Islands Colombia Comoros Congo Cook Islands Costa Rica Cote d'Ivoire Croatia Cuba Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Eswatini Ethiopia Falkland Islands Faroe Islands Fiji Finland France French Polynesia Gabon The Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guernsey Guinea Guinea-Bissau Guyana Haiti Honduras Hong Kong Hungary Iceland India Indonesia Iran Iraq Ireland Israel Italy Jamaica Japan Jersey Jordan Kazakhstan Kenya Kiribati North Korea South Korea Kosovo Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macau Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia Moldova Monaco Mongolia Montenegro Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island Northern Mariana Norway Oman Pakistan Palau Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Islands Poland Portugal Puerto Rico Qatar Romania Russia Rwanda Saint Barthelemy Saint Helena Saint Kitts and Nevis Saint Lucia Saint Martin Saint Pierre and Miquelon Saint Vincent and the Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands Somalia Somaliland South Africa South Ossetia Spain Sri Lanka Sudan Suriname Svalbard Sweden Switzerland Syria Taiwan Tajikistan Tanzania Thailand Timor-Leste Togo Tokelau Tonga Trinidad and Tobago Tristan da Cunha Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu Uganda Ukraine United Arab Emirates United Kingdom Uruguay Uzbekistan Vanuatu Vatican City Venezuela Vietnam British Virgin Islands US Virgin Islands Wallis and Futuna Western Sahara Yemen Zambia Zimbabwe Other Country Please charge my credit card in 10 monthly installments (October 2020 - July 2021). Please charge my credit card in 3 monthly installments (October, November, December 2020). Comments? Questions? As the parent(s) or legal guardian of the above child, I/we authorize any adult acting on behalf of the Community 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, Community 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 Community Hebrew School activities and that these pictures may be used for marketing purposes. I accept. Full Name Initials E-mail* Cel Phone Number* We look forward to a wonderful year of learning and growth! 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