Enrollment & Tuition Fees

STUDENT INFORMATION

Surname :

Given Names :

Hebrew Name :

School (September 2019)

Grade (September 2019)

Our contact numbers, email and mailing addresses remains the same.

 

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

 

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 are not 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 :

 

TUITION & BILLING FORM

SEPTEMBER 10TH 2019 – JUNE 2nd 2020

  • 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, 2019.I will be paying the tuition in 2 payments. Payment #1 is due on September 1st, 2019 and payment #2 is due on December 1st, 2019. Your credit card will be charged on December 1st, 2019.I will be paying tuition in 8 monthly payments from September 20th 2019 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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