TAG HEBREW SCHOOL 

REGISTRATION FORM - 2011/2012

***** One form per child please *****

For current students it may be enough to fill out sections 1 and 4.

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Section 1 - Child's Information

  

Child's Name: 

Child's Hebrew Name:  

Birth Date:       Appr. time of the day:

Age:       Grade:

Child's Address: 

Child's Phone Number:

Child's Email Address:  

Previous Hebrew School or Day School Attendance:

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Section 2 - Family Information

 

Mother's Name:

Mother's Hebrew Name:

Mother's Address:

Mother's Phone Number: 

Mother's Email Address:  

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Father's Name:

Father's Hebrew Name: 

Father's Address:

Father's Phone Number:   

Father's Email Address:   

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Family Synagogue Affiliation (if any) 

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Section 3 - Emergency Information

 

Emergency Contact:

Contact's Phone Number:  

Family Doctor:          

Doctor's Phone Number:   

 

Special needs [allergies or any other medical issues]

 

Special needs [any psychological or behavioral issues]

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Section 4 - Payment information

 

Total tuition:       

Payment Method:

          credit card payments (please chose 1, 2, 4, or 8)

          post-dated checks (please chose 1, 2, 4, or 8)

Deposit of $100 to be applied against tuition:   

        I will mail a check   

        I will call the office with my card number

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