Jecsfl Hebrew School Registration Form

JECFUN FAMILY HEBREW SCHOOL

Office: 3600 NW 2nd Court • Boca Raton, FL 33431

Phone: (561) 544-2854 x 2 • Fax: (561) 847-3533

Email: • Web:

welovehebrewschool

Rabbi Yisroel Hecht, Principal

REGISTRATION FORM: 2016-17SCHOOL YEAR

(If you’d like to register online, please see the instructions listed at the end of this application)

CLASSES:

LOCATION:

Sundays 9:30AM -12:00 PM

Olympic HeightsHigh School

20101 Lyons Road

Boca Raton, FL 33434

Date: ______

How did you hear about our Hebrew School?

 Friend ______(Parents who refer friends are eligible for a tuition discount)

(Name)

CHILD’S INFORMATION

Last Name ______First Name______Age _____

Hebrew Name______Birth Date _____/_____/_____  Male Female

Child’s Grade for ’16-’17 school year _____ Primary School ______

(For multiple children, please attach a separate sheet of paper with the same above info for each child)

Address ______City______State ______Zip______Phone (home) ______

Are there any important educational or medical needs we should know about your child? ______

Is your child currently on any medication? ______

Describe child’s previous Jewish education if any: ______

______

What benefits would you like to receive from our School? ______

PARENTS’ INFORMATION

Father’s Name / Hebrew Name (if known)
Father's Occupation / Company’s Name
Father’s Cell Phone / Father's E-mail
Father Born Jewish  Not Jewish / Converted to Judaism
Mother’s Name (Include Maiden Name) / Hebrew Name (if known)
Mother's Occupation / Company’s Name
Mother’s Cell Phone / Mother's E-mail
Mother  Born Jewish  Not Jewish / Converted to Judaism

Describe parents’ Jewish education: ______

FAMILY STRUCTURE

 Two Parents (Please indicate if a spouse is not child’s biological parent______)

 Single Parent (Child Lives with ______)

SIBLING INFORMATION

Child’s Name ______Age _____

GRANDPARENTS’ INFORMATION

Paternal Grandparents: / Maternal Grandparents:
Names / Names
Hebrew Names (if known) / Hebrew Names (if known)
Street Address / Street Address
City, Zip / City, Zip
Phone Number / Phone Number
E-mail / E-mail

EMERGENCY CONTACT - Please provide contact information of someone(OTHER THAN A PARENT)that we can contact in case of emergency:

Name ______Relation______

Phone (cell) ______Email ______

Do you have any friends who would be interested in this program?  Yes  No

Name ______Phone Number ______

TUITION INFORMATION

Tuition for the school year is $850 per child registering, whichincludesa $100 registration fee(which will be waived for any registrations submitted by Wednesday, June 8, 2016).I understand that registration is not complete until tuition is paid in FULL.[For scholarshipopportunities or to be placed on a payment plan, please inquire with our office before registering.]

PAYMENT OPTIONS:

 Checkenclosed (payable to “JEC of South Florida”)

 Credit Card(ONLY IF SENDING APPLICATION VIA MAIL):

 Visa  MasterCard  Amex

Card #______

Exp.______/______Billing Zip Code______

Please place a check in each box:

 I would like my child to attend the JEC FunFamily Hebrew School, administeredby the Jewish Education Center of South Florida for the 2016-17 school year.

 Iunderstand that registration in the Hebrew School is not complete until the JEC of South Florida receives FULL tuition payments of $850, per child registering.

 Enclosed is $850(per child registering), or credit card information for JEC to charge the appropriate tuition payments

*** I understand that final acceptance in the Hebrew School will be decided after an interview with the Hebrew School Principal. ***

Parent’s Name: ______Signature ______Date ______

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You can send us this application in either of the following ways:
MAIL
(With payment or payment info) / ONLINE
JEC Fun Family Hebrew School
Hebrew School Registration Form
3600 NW 2nd Court
Boca Raton, FL 33431 / Register and pay online at:

Feel free to call our office at 561-544-2854 x 2 with any questions or for more information, or speak to Rabbi Hecht, our principal, at x 103