Enrollment & Tuition Fees

Track

  • In Person Track - Our In person track will take place on Tuesdays from 3:30-5:30pm. There will be small classes and will strictly follow CDC guidelines in relation to Covid-19.Virtual Track - Our virtual track will take place on Zoom on Wednesday from 3:15-4:30pm. All Supplies + Materials will be provided and will include a one-on-one 15 minute Aleph Champ phone call with your child's teacher.

STUDENT INFORMATION

Surname :

Given Names :

Hebrew Name :

Date of Birth :

What time was your child born? :

Am/pm

School (September 2019)

Grade (September 2019)

Prior Schools:

Past Hebrew Lessons :
NeverVillage HebrewPrivate TutorOther

specify

Gender :
MaleFemale

Home Address of child :

Street Address:

Apt :

Zip :

City :

Child lives with :

Cultural Background :

Language used at home :

Is the natural mother of the child Jewish?
YesNo

Were there any conversions or adoptions in your family?
YesNo

If yes, please describe :

 

PARENT INFORMATION

PARENT OF CHILD

Title:

Surname:

Given Name:

Hebrew Name :

Occupation :

same as child’s Address :

Home Address :

Street Address:

Apt :

Zip :

City :

Home Telephone :

Work Telephone :

Cell Phone :

Email :

Country of Birth :

Main Language :

Synagogue Affiliation :

 

PARENT OF CHILD

Title:

Surname:

Given Name:

Hebrew Name :

Occupation :

same as child’s Address :

Home Address :

Street Address:

Apt :

Zip :

City :

Home Telephone :

Work Telephone :

Cell Phone :

Email :

Country of Birth :

Main Language :

Synagogue Affiliation :

Main Expectation : Jewish HeritageHebrewSocial Jewish EnvironmentAll

Main email correspondence : MotherFatherbothPrimary mail correspondencemotherFatherboth

Marital Status :

Rabbi/Officiator :

 

MEDICAL & SPECIAL NEEDS DETAILS

Is your child taking permanent medications?
NoYes

specify :

Any known allergies (incl. reactions to medications) and any present medical conditions? NoYes

specify :

allergiesnut allergyasthmaanaphylaxisother

Other :

Does your child require the use of an epi-pen?

 

Is your child gluten-free?

Please list 2 snacks your child will enjoy :

 

EMERGENCY INFORMATION

Emergency Contact :

Relationship to child :

Home Telephone :

Cell Phone :

Doctor’s Name :

Doctor’s Telephone :

Doctor’s Address :

Zip :

City :

 

OTHER PERSON AUTHORIZED TO PICK-UP CHILD

Name :

Relationship to Child :

Cell Phone :

Address :

Zip :

City :

 

Village Hebrew currently offers school pick-up

Please click below if you would like more information :
Larchmont Charter - Fairfax CampusWest Hollywood Elementary

 

GENERAL INFORMATION

I authorize my home telephone number and email address to be published in a class list.

I can help Village Hebrew with occasional volunteering

How did you find out about Village Hebrew :

 

ACCIDENT, FIELD TRIP & PRIVACY DECLARATION

Accident: As the parent(s) or legal guardian of :

I/we authorize any adult acting on behalf of Village Hebrew School to hospitalize or secure treatment for my child, I further agree to pay all charges for that care and/or treatment. It is understood that if time and circumstances reasonably permit, Village Hebrew School personnel will try, but are not required to communicate with me prior to such treatment.

Trips & Outings: I hereby give permission for my child to attend and participate in all trips and outings organized as part of the program by Village Hebrew.

Privacy: I hereby give permission for my child’s photographs/videos to be used for educational or promotional purposes, which include but arenot limited to, brochures, Village Hebrew website and Village Hebrew social media. I understand that I can withdraw my consent at any time.

Signature of parent or legal guardian :

Date :

Signature of parent or legal guardian :

Date :

 

COVID 19 WAIVER

Acceptance of Risk; Release; and Indemnification.

On March 4, 2020, California Governor Gavin Newsom declared a disaster emergency for California relating to the COVID-19 outbreak. On March 11, 2020, the World Health Organization declared the COVID-19 outbreak a global pandemic. On March 13, 2020, President Donald Trump declared the COVID-19 outbreak a national health emergency. Given the severity of the COVID-19 pandemic, and in anticipation of my child attending Village Hebrew extracurricular program, I hereby make the following waiver, release and other representations and covenants set forth herein, on behalf of myself, my child, and in favor of this Facility.

The safety and security of the children in its care remains a top priority of Village Hebrew. I understand that there is a risk associated with my child’s return to care at Village Hebrew, including but not limited to, increased social contact and interaction with Village Hebrew employees and other children that may lead to exposure to COVID-19 leading to severe illness such as fever, coughing, body aches, shortness of breath or difficulty breathing, chills, muscle pain, sore throat, confusion, persistent pain or pressure in the chest, loss of taste or smell, inability to wake or stay awake, respiratory ailments, hospitalization, pneumonia and/or death. To help reduce the spread of COVID-19 and to protect Village Hebrew employees and other children, Village Hebrew encourages all children and parents to adhere to all safety and health guidelines for the prevention of COVID-19, including those issued by the California Department of Public Health and the Centers for Disease Control and Prevention. All persons should engage in frequent hand washing using soap and water.

Notwithstanding the foregoing, I understand that the above guidelines do not completely eliminate my child’s risk of exposure to COVID-19 and, should my child experience any COVID-19 related symptoms (such as fever, cough, body aches, or shortness of breath or difficulty breathing, chills, sore throat, new loss of taste or smell), I shall keep my child home, not to bring my child to Village Hebrew, and follow the advice of my healthcare provider, clinic, or hospital. In such cases, I will immediately alert Village Hebrew of such symptoms.

Regardless of any steps taken by Village Hebrew to reduce the risks associated with the COVID-19 pandemic, I am fully aware that there are a number of risks associated with my child’s care at Village Hebrew during the COVID-19 pandemic, including without limitation, being exposed to and contracting COVID-19 from other individuals, surfaces and/or airborne particles. I understand that my or my child’s contracting of COVID-19 could result in serious medical symptoms leading to medical treatment, hospitalization or even death. On behalf of myself and my child, and our heirs, successors, and assigns, I knowingly and freely, assume all such risks, both known and unknown, relating to my child’s care at Facility arising from or relating to COVID-19, including all illnesses, injuries, damages or death arising therefrom, and I hereby forever release, waive, relinquish, and discharge Village Hebrew, along with Village Hebrew’s shareholders, officers, directors, members, managers, officials, partners, trustees, agents, contractors, employees, affiliates, or other representatives, and their successors and assigns (collectively, the “Village Hebrew representatives”), from any and all claims, demands, liabilities, rights, damages, expenses, and causes of action of whatever kind or nature, and other losses of any kind, whether known or unknown, foreseen or unforeseen, (collectively, “Damages”) arising from or relating to COVID-19 as a result of my child’s care at Village Hebrew and including but not limited to claims based on the alleged negligence of any Facility Representative or any other person. I further promise not to sue Village Hebrew or any Village Hebrew Representative for any illness, injury, death or other Damages arising out of or related to COVID-19 and agree to indemnify and hold them harmless from any and all Damages resulting therefrom as a result of my child’s care at Facility.

If any provision of this Waiver and Release of Liability is declared invalid, the remaining provisions remain enforceable. I may seek advice from legal counsel before signing this Waiver and Release of Liability. By signing this Waiver and Release of Liability, I acknowledge that either I have sought the advice of legal counsel or wish to waive the opportunity to seek the advice of counsel before signing.

READ CAREFULLY -- BY SIGNING THIS DOCUMENT YOU MAY GIVE UP IMPORTANT LEGAL RIGHTS.



TUITION & BILLING FORM

  • Kindergarten-5th Grade Tuition - $795 / Book Fee - $30 / Security Fee - $50
  • 6th Grade – 7th Grade Tuition - $795 / Book Fee - $30 / Security Fee - $50
  1. 10% off tuition for second sibling
  2. Tuition fee covers all weekly programs, both Hebrew language & Jewish heritage studies, snacks & drinks.
 

DEPOSIT

A non-refundable deposit of $100 per child is needed to secure your child’s spot in Village Hebrew. This will be taken off the sum of your tuition.

 

PAYMENT METHOD

  • Please choose a tuition payment option :
  • I will be paying tuition in full by September 1st, 2020.I will be paying the tuition in 2 payments. Payment #1 is due on September 1st, 2020 and payment #2 is due on December 1st, 2020. Your credit card will be charged on December 1st, 2020.I will be paying tuition in 8 monthly payments from September 20th 2020 to April 20th 2020. Credit card will be charged on the 20th of each month.

 

CREDIT CARD INFORMATION

VisaMastercardAmerican Express

Card #:

Name on card :

Expiration :

Sec :

Signature :

Billing Address :

Zip :

 

PROGRAM & TUITION DECLARATION

I hereby confirm my child’s enrollment in Village Hebrew’s afternoon school.

I represent that I am the custodial parent or legal guardian of the child that I am enrolling and that the information I have provided is true and correct. I agree to Village Hebrew’s terms and conditions as outlined in the Parent Handbook (emailed to parents).

I fully understand that this enrollment, as part of my commitment to a long-term Jewish education at Village Hebrew, is accepted only on the basis of the full year program, and agree to pay the full annual fees accordingly. I understand that no refunds or adjustments will be made for absences including, but not limited, to illness or vacation.

Signature of parent or legal guardian:

Date :

Signature of parent or legal guardian:

Date :

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