Hebrew High Grades 10-12 How many children are you registering today?* 1 2 3 Child 1 Name* First Last Hebrew Name DOB* MM slash DD slash YYYY Age*Please enter a number from 5 to 12.School Grade Entering*TenthEleventhTwelvethIn person class options:* Sunday 10:00am - 12:00pm Second ChildChild 2 Name* First Last Hebrew Name DOB* MM slash DD slash YYYY Age*Please enter a number from 5 to 13.School* Grade Entering*KindergartenFirstSecondThirdFourthFifthSixthSeventhIn person class options:* Sunday 10:00am - 12:00pm Third ChildChild 3 Name* First Last Hebrew Name DOB* MM slash DD slash YYYY Age*Please enter a number from 3 to 12.School* Grade Entering*KindergartenFirstSecondThirdFourthFifthSixthSeventhIn person class options:* Sunday 10:00am - 12:00pm Previous Jewish Education? Yes No Where? Please provide details:Parent/Guardian InformationParent/Guardian 1* First Last Cell Phone Number*Parent/Guardian 1 Email* Parent/Guardian 2 First Last Cell Phone NumberParent/Guardian 2 Email Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Persons to be contacted in case of an emergency when parents cannot be reached.Name 1* First Last Phone*Relationship to child* Name 2 First Last PhoneRelationship to child Other person(s) authorized to pick up child(ren)Name of Authorized Person First Last Cell Phone of Authorized PersonRelationship of Authorized Person General InformationCONFIDENTIAL: Does your child have any allergies or other medical condition, require medication, or any special abilities or disabilities we should be aware of?* Yes No Please describe them and indicate special precautions or care needed.As the parent(s) or legal guardian of the above child, I/we authorize any adult acting on behalf of CHS to hospitalize or secure treatment for my child, I further agree to pay all charges for that care and/or treatment.* I Accept It is understood that if time and circumstances reasonably permit, CHS 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.* I Accept I hereby give permission for my child to be photographed while participating in CHS activities and that these pictures may be used for marketing purposes. I Accept Payment OptionsRates: K - 7th Grade: $1800Tuition Plans - 1 Child Plan A: One Full Tuition Payment - $1,800 Plan B: Pay $250 non-refundable registration fee (included in the tuition), with 8 Equal payments charged on the first of each month Sept- April. $250 due today. Tuition Plans - 2 Children Plan A: One Full Tuition Payment - $3,600 Plan B: Pay $250 non-refundable registration fee (included in the tuition), with 8 Equal payments charged on the first of each month Sept- April. $500 due today. Tuition Plans - 3 Children Plan A: One Full Tuition Payment - $5,400 Plan B: Pay $250 non-refundable registration fee (included in the tuition), with 8 Equal payments charged on the first of each month Sept- April. $750 due today. Payment Method* Check Credit Card Please check one option.Total $0.00 You'll submit your credit card information for payment after you click SUBMIT.Name* Initials* We look forward to a wonderful year of learning and growth!
