New Student Enrollment Form

Get started for an outstanding Jewish and Hebrew education for your child.

Enrollment process

Fill out the enrollment or re-enrollment form and submit $100 deposit.
Once your form & deposit is received, you will receive an email confirming your child’s enrollment.
You will receive a welcome packet including the parent handbook and school calendar in early September.

Student Name

First Name

Last Name

Hebrew Name

Date of Birth

YYYY

What time was your child born

Hour

Minute

Second

School Entering (September 2023)

Grade Entering (September 2023)

Past Jewish Studies lesson

Home Address of child:

Child lives with:

Cultural Background:

Language used at home:

Is the natural mother of the child Jewish

Are there any conversions or adoptions in your family? If yes, please describe:

PARENT INFORMATION

PARENT OF CHILD - 1

Title:

Surname:

Given Name:

Hebrew Name:

Occupation:

Home Address:

Cell phone:

Country

(###)

###

####

Email:

Country of Birth:

Main Language:

Synagogue Affiliation:

PARENT OF CHILD - 2

Title:

Surname:

Given Name:

Hebrew Name:

Occupation:

Home Address:

Cell phone

Country

(###)

###

####

Country of Birth

Main Language

Synagogue Affiliation

Main Expectation at Village Hebrew:

Main email correspondence:

MEDICAL & SPECIAL NEEDS DETAILS

Is your child taking permanent medication? If yes, please specify

Any known allergies(incl. reaction to medication)and any present medical conditions? Specify

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

Is your child gluten-free? Please list 2 snacks your child will enjoy:

Emergency Contact:

First and Last Name

Relationship to child:

Emergency contact Cell phone:

Country

(###)

###

####

Doctors Name:

Doctor's Telephone:

Country

(###)

###

####

Doctor's Address:

OTHER PERSON AUTHORIZED TO PICK-UP CHILD

NAME

Relationship to child:

Cell phone:

Country

(###)

###

####

Address:

ACCIDENT, FIELD TRIP & PRIVACY DECLARATION

ACCIDENT: As the parent(s) , I/we authorize any adult acting on behalf of Village Hebrew 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 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 website and Village social media. I understand that I can withdraw my consent at any time.

Signature of parent or legal guardian

TUITION - September 2023-MAY 2024 - $1095

● Tuition fee covers all weekly programs, both Hebrew language & Jewish heritage studies, snacks & drinks. ● There is a 10% tuition discount for a second sibling ● There is a $100 tuition credit per family if you refer another family to Village Hebrew ● 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.

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.

CREDIT CARD INFORMATION

Visa / Mastercard / American / Express

Card Number

Name on card:

Expiration:

MM/YEAR

Security Code:

Signature:

Billing Zip Code:

Billing Address:

PROGRAM & TUITION DECLARATION

I 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:

YYYY

Name

First Name

Last Name

Subject

Message

Find Us

	323-508-3522
	info@villagehebrew.com
	7866 Fountain, Avenue West Hollywood, CA 90046

A vibrant Jewish educational experience for the next generation.

New Student Enrollment Form

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