Registration 2023 2024

FREE HEBREW REGISTRATION 2023-24
Please fill out 1 form per child.

Please note registration fees are non refundable.

To Register for Carlyle School Lunch Program 2023-24- Please CLICK HERE!
Registration Options*

Sunday School -10:00am-12:30pm (Or Shalom- 96 Fredmir St., DDO) $229/$219 (second child) all gradesLunch Program on Thursdays $89 - If selected please choose the school belowLunch Program THURSDAYS @ Friendship Circle 12pm-12:45pm- $89After School Program $229/$219 (second child) - If selected please choose the school belowTuesdays @ Or Shalom in DDO $229/$219 (second child) 4:15PM-5:30PM
Which School for Lunch Program?
Which School for After School Program?
STUDENT
Full Name*

First Name Last Name
Hebrew Name*
Birth Date*

Month Day Year
Time Born* In Judaism the day begins at nightfall, so the exact Jewish birthday will depend on the birth being before or after sunset.

Before SunsetAfter Sunset
School Attending*
Grade Entering as of Sept 2023*
Hebrew Reading Proficiency

NoneSomewhatWell
Previous Jewish Education*

YesNo
CONFIDENTIAL: Does your child have any allergies or other medical condition we should be aware of? If yes, please describe them and indicate special precautions or care needed.*
PARENT INFORMATION
Father's Name*
Father's Hebrew Name*
Father's Cell #*
Father's Email Address*
Father's Business Name
Father's Position
Father's Business Address
Mother's Name*
Mother's Hebrew Name*
Mother's Cell #*
Mother's Email Address*
Mother's Business Name
Mother's Position
Mother's Business Address
What is your instagram account? So we can tag you in pictures

Home Address*

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

Parent's Status*

SingleMarriedDivorcedWidowedSeparated
Language Spoken at Home
Congregation Affiliation
EMERGENCY INFORMATION
Emergency Contact 1*
Phone #1*
Emergency Contact 2*
Phone #2*
Medicare Card #*
BROTHERS & SISTERS
Name
Birthdate
School Attending
Name
Birthdate
School Attending
PAYMENT
Amount Paying for Sunday School*

$229$219
Amount Paying for After School Program*

$229$219
Amount Paying for TUES After School Program*

$229$219
Amount Paying for Lunch Program*

$89
Amount Paying for THURSDAYS @ Friendship Circle Lunch Program*

$89
NEW- Party Fee $25/child for the year*

$25
Total

$0.00

Payment

Credit Card

We accept Visa, MasterCard, American Express, Discover
Credit Card Number	Security Code
Name on Card
Expiration Month	Expiration Year

Billing Address

Street Address

City

State / Province

Postal / Zip Code

Country

Email Address to send confirmation of Registration:
E-mail Address*
PICK UP INFORMATION
In order to ensure that every child gets picked up safely, please fill in the following information:
Does your child walk home by him/herself?*

YesNo
Does your child go to late class?*

YesNo
If not, who picks him/her up?*
What is this person's relation to the child?*
Any Additional information we should be aware of:*
As the parent(s) or legal guardian of the above child, I/we authorize any adult acting on behalf of Free Hebrew for Juniors 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, Free Hebrew for Juniors personnel will try, but are not required, to communicate with me prior to such treatment. I hereby give permission for my child to participate in all school activities, join in class and school trips on and beyond school properties and allow my child to be photographed while participating in Free Hebrew activities and that these pictures may be used for marketing purposes. I agree not to register my child(ren) in any other program (i.e. hockey, swimming etc.) during the same hours as Hebrew school.
I accept*

YESNO
I hereby give permission for my child to participate in all school activities, join in class and school trips on and beyond school properties and allow my child to be photographed while participating in Free Hebrew activities and that these pictures may be used for marketing purposes. I agree not to register my child(ren) in any other program (i.e. hockey, swimming etc.) during the same hours as Hebrew school.
I accept*

YESNO
I would like to receive news and updates by email
Should be Empty:

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Programs

Registration 2023 2024

STUDENT

PARENT INFORMATION

EMERGENCY INFORMATION

BROTHERS & SISTERS

PAYMENT

PICK UP INFORMATION

AFTER SCHOOL, LUNCH PROGRAM & SUNDAY SCHOOL

KIDS MAKE SHABBAT

LAYLA TOV & BIRTHDAY CLUB

C TEEN PROGRAM

BAR & BAT MITZVAH CLUB

WOMEN'S CIRCLE