Hebrew School Application with Payment 2021-2022

Address*

Father's Address if different than Mother's
Mother's Cell*

Area Code Phone Number
Mother's E-mail*
Father's Cell*

Area Code Phone Number
Father's Email*
Emergency Information
Emergency Contact*
Phone Number*

Area Code Phone Number
Is there any special medical information or learning difficulties the school should be aware of regarding your child?*
Emergency Consent Form: I, the undersigned, the parent or legal guardian of the child named in the registration form, do hereby give authorization for professional medical personal to provide emergency medical treatment in the event that neither parent (guardian) can be contacted for such permission.
Sign and Date*
Payment Information
Scholarships available upon request.
Tuition:

$750 (one student)

$1,450 (two students)

$2,175 (three students)

Price includes books.

Payment

Credit Card Check

Postal / Zip Code

Country

Amount

$750
Amount

$1450
Amount

$2175
I do hereby grant permission to The Charleston Center for Jewish Life to take and use: photographs, videotape and/or digital images of my child for use in promotional or educational materials pertinent to the Hebrew School program.

Yes No
Should be Empty:

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Child's Information