Hebrew School Application

Birth Date(Required)

Bar/Bat Mitzvah date (if set)

School Grade(Required)

Please enter a number less than or equal to 12.

Name Of School(Required)

Email(Required)

Phone(Required)

Parent 1 Email(Required)

Parent 1 Work Place(Required)

Parent 1 Home Phone(Required)

Parent 1 Work Phone

Parent 1 Cell Phone

Parent 2 Email

Parent 2 Work Place

Parent 2 Home Phone

Parent 2 Work Phone

Parent 2 Cell Phone

Emergency Contact Phone(Required)

Physician's Name/Name of Practice(Required)

Physician's/Practice Phone(Required)

Insurance Company Name(Required)

Plan/Group#(Required)

Policy #(Required)

Medical Or Food Allergies

Please be as descriptive as possible!

Questions/Comments/Concerns

PreK to 2nd Grade

Please enter a number from 0 to 20.

$175.00 per child in Sunday School + Junior Congregation (PreK to 2nd grade)

3rd Grade

Please enter a number from 0 to 20.

$300.00 per child in Weekday and Sunday School + Shabbat Services/Junior Congregation (3rd Grade)

4th to 7th Grades

Please enter a number from 0 to 20.

$400.00 per child in Weekday and Sunday School + Shabbat Services/Junior Congregation (4th – 7th grades)

a 10% discount has been applied for already having a sibling enrolled!

Non-members, Please contact the synagogue office for further information about non-member fees.

School Fee For Members

Price: $0.00