Printed from JewishMalibu.com

Application

Application

We are currently accepting applicants for the 2015-2016 school year. Please fill out all fields below. Please contact the office if you have any questions or concerns. Confirmation of acceptance is acknowledged only after registration form is reviewed.

Recommend a new student and receive a 10% discount*. An additional 10% discount* is applied, from the original total, for each new student you recommend.

Student Profile #1
First Name
Last Name
Hebrew Name
Gender
DOB
School
Grade Entering (Aug. 2014)
Student Profile #2
First Name
Last Name
Hebrew Name
Gender
DOB
School
Grade Entering (Aug. 2014)
Family Information
My child is a
Are the natural father and mother of the child Jewish? Yes No
If no, please explain.
Have there been any conversions or adoptions in the family? Yes No
If yes, please explain.
Are you interested in carpooling? Yes No
If yes, can we give your number to other parents? Yes No
How did you hear about us?
Parents Information
Father's Name
Cell
Email
Mother's Name
Mobile
Email
Address
City
Zip
Home Phone
Emergency Information
Emergency Contact 1
Phone
Relationship
Emergency Contact 2
Phone
Relationship

CONFIDENTIAL: Does your child have any allergies or other medical condition we should be aware of? If yes, please describe them and indicate special precautions or care needed.

Payment Options (both options include registration and book fees)
Pay Full Tuition: $1000 per child
Pay Deposit: $100 per child. Remaining balance 1st of the month from Sept 2015 - May 2016
Promotional Code:
Card Type
Card Number
Exp. Date
CCV Number (on back of card)
Comments (optional)

*Discount received once new student's tuition is paid in full, $1,000 per child. To receive discount, have your recommendee state your name in the box titled, How did you hear about us?

I understand that my deposit of $100 is non-refundable, that full payment is due by September 1st, 2015, at which time the balance of tuition becomes non-refundable, and that refunds will not be made for incomplete attendance. The parent/guardian who signs this registration form represents that he/she has full authority to do so and will be responsible for payment of the Hebrew School fees.

I Accept

Name:

We look forward to a wonderful year of learning and growth!

Secure This page uses 128 bit SSL encryption to keep your data secure.