Merton 2024-25

Please note it is 1 form per child.

Please note registration fees are non refundable.

Child's Full Name*

First Name Last Name

Child's Hebrew Name

Child's 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

Child's grade as of Sept 2024*

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.*

Father's Full Name*

First Name Last Name

Father's E-mail*

Father's Phone Number*

Father's Business Name

Father's Position

Father's Business Address

Mother's Full Name*

First Name Last Name

Mother's Hebrew Name*

Mother's E-mail*

Mother's Phone Number*

Mother's Business Name

Mother's Position

Mother's Business Address

Home Address*

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

I'd like to be part of the Free Hebrew Parents committee at Merton!*

YESNO

We'd also be interested in:*

Full Name

First Name Last Name

Birth Date

Month Day Year

School Attending

Full Name

First Name Last Name

Birth Date

Month Day Year

School Attending

Which shift will your child attend?*

Paying for Merton After School* $229/child. $219/2nd child

Would you like to sponsor a pizza party for your child's class?

$36.00$50.00

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

In order to ensure that every child gets picked up safely, please fill in the following information:

After class my child goes to:*

DaycareGets picked up

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 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

Registration is not complete until you hear back from us by email or phone.

All new students are accepted on a trial basis.

FREE HEBREW - PELO PROGRAM AT MERTON

PARENT INFORMATION

BROTHERS & SISTERS (that are not registered in our program)

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