Virtual HS Registration Semester Alef 2022

JRCC/IAC Ofek Project
Online classes take place Thursdays from 5:00-6:30 p.m.
Course fee is $350 for 14 sessions from October 7 to February 10, 2022.
|Student Information
Full Name*
First NameLast Name
Jewish Name*
Child's email (if applicable)

Address*

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Phone Number*
Area CodePhone Number
Age
Birthday*
MonthDayYear
at HourMinutes
School Attending*
Grade as of Sep 2021*
|Parental Information
Marital Status*
MarriedDivorcedSeparated
Father Information
Full Name*
First NameLast Name
Hebrew Name*
Occupation
Mobile*
Area CodePhone Number
Work Phone
Area CodePhone Number
E-mail*
Father's Jewish Identity*
Mother is JewishFather is JewishNot Jewish
Mother Information
Full Name*
First NameLast Name
Hebrew Name*
Occupation
Mobile Phone*
Area CodePhone Number
Work Phone
Area CodePhone Number
E-mail*
Mother's Jewish Identity*
Mother is JewishFather is JewishNot Jewish
|Additional Information
Does your child read Hebrew?
Understand/speak Hebrew Language
Any learning difficulties, please specify.
Previous formal Hebrew Education
Are there any conversions or adoptions in the family?*
Emergency Contact*
First NameLast Name
Relationship to child*
Cell Phone Number*
Area CodePhone Number
Any other information that would be helpful to best care for your child
|Payment Information
Final Confirmation*
Yes, I would like to register my child - $350 course fee

Registration Fee Payment*

Credit Card

Credit Card Type
Credit Card Number	Security Code
Name on Card
Expiration Month	Expiration Year

Billing Address

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Country

Please note: In the event of a student withdrawing from Hebrew School, tuition fees will be returned on a prorated basis applied upon written or emailed notification of the withdrawal. The registration fee charged upon submission of this application.
Total Fees
$0.00
Yes, I'd like to donate the cost of processing this transaction by adding 3%
Tuition Payment Options*
One time credit card paymentCredit card payments in up to 2 installments - using the card I submitted above. (Please outline your preferred breakdown in the notes below.)Cheque (up to 5 post-dated payments.)
I would like to assist a child who cannot afford Hebrew School Education
|Consent
As the parent(s) or legal guardian of the above child, I/we authorize any adult acting on behalf of JRCC Hebrew School to hospitalize or secure treatment for my/our child, I/we further agree to pay all charges for that care and/or treatment. It is understood that if time and circumstances reasonably permit, JRCC Hebrew School personnel will try, but are not required, to communicate with me/us prior to such treatment.
I/we hereby give permission for my/our child to participate in all school activities, join in class and school trips on and beyond school properties and allow my/our child to be photographed while participating in Hebrew School activities. I/we also understand that all liability and costs resulting from damage to property and/or personal injury caused or attributable to my/our child/children will be my/our responsibility.
Type your name as a signature*
*
MonthDayYear
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