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We are currently accepting application forms for the 2010-2011 school year. Please fill out ALL fields of this form. If you have any questions or concerns you'd like to discuss with us, or would like to request a printable registration form please contact us.
Please note that one registration form per child is needed.
We looforward to a wonderful year of learning and growth.
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Student Information
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| Family Name |
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Child's First Name |
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Hebrew Name
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Gender |
Male Female |
| Date of Birth |
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| Does your child speak/understand Hebrew? |
None Somewhat Well |
| Does your child have previous Jewish education? |
Yes No |
| If Yes please describe |
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| What school does your child attend? |
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Has your child ever had a psychological assessment?
Yes No
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If yes, date: |
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| Is there anything else we should know about your child? |
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| Synagogue affiliated with |
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| Have there been any conversions or adoptions in the family, if yes please explain? |
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| Please name other children that you are registering: |
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| Name |
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Age & Date of Birth |
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| Name |
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Age & Date of Birth |
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| Please place my child with the following friends |
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Parent Information
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| Father's Name |
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Home Phone |
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| Work Phone |
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Email adress (home) |
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| Cell |
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Occupation |
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| Home Address |
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Home City |
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| Home Province |
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Home Postal Code |
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| Marital Status |
Married |
Separated |
Divorced |
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If divorced |
Stepfather how long |
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Stepmother how long |
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| Mother's Name |
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Home Phone |
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| Work Phone |
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Email Adress (home) |
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| Cell |
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Occupation |
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| Home Address (If different then above) |
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Home City |
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| Home Province |
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Home Postal Code |
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Emergency Contact Information
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| Plese list two contact to be used in case of emergencies |
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| Name 1 |
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Relationship to child |
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| Home Phone |
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Cell |
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| Name 2 |
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Relationship to child |
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| Home Phone |
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Cell |
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Confidential
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| Does your child have any allergies, other medical conditions or special needs we should be aware of? |
| Yes No |
If yes, please describe them and indicate special precautions or care needed. |
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As the parent(s) or legal guardian of the above child, I/we authorize any adult acting on behalf of Hallandale 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, Hallandale 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 and I/we agree to fully indemnify and save Hebrew School and it’s associates, teachers and agents harmless therefrom. I/we consent to Hallandale Hebrew School’s use of our personal information and of our child/children at its discretion in pursuit of school activities.
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Initial |
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Tuition Fees
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| Click one box |
Day |
*Reg & Book Fee |
Tuition |
Total
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Location
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Sunday 10:00 -12:15 pm
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$55.00 |
$515.00
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$570.00
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1295 E. Hallandale Bch Blvd
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Wednesday 3:45pm-5:15pm |
$55.00 |
$515.00 |
$570.00
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Sundays & Wednesdays |
$55.00 |
$820.00 |
$875.00 |
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*This is non-refundable and due in full at the time of registration.
Registration & book fee must be paid in full at time of registration and not included in tuition fees.
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Payment Methods
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You may choose from the following payment methods:
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The tuition can be paid in full when registering your child.
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| Alternatively, it could be broken up into three equal payments. (registration fee must be paid at time of registration) |
- 1st payment is due August 15.
- 2nd payment is due September 15.
- 3rd payment is due October 15.
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Head-checks dated for each of these dates are due at registration.
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Please make all checks payable to Hallandale Hebrew School and submit them together with the registration form.
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Refunds for children withdrawing from school before the end of the school year will be pro-rated up to February 1 provided that the school office is given 30 days written notice and does not include the registration fee. Tuition refunds will not be granted to children withdrawing from school after February 1. There are no refunds or credits for days missed due to illness, holidays, or family vacations.
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Charitable tax receipts will be issued for the full amount of all tuition fees paid.
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Billing Information
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| I would like to assist a child who cannot afford Hebrew School Education. |
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| Cash |
Check |
(Applications will be processed upon receiving of payment) |
| Credit Card |
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| Name on card |
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| Card # |
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Expiry |
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| I heard about the Hallandale Hebrew School Hebrew Club from ( if you are registering before July 15th the $50 will utomatically be credited) |
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