Contact Information
Child's Name:
First Name
Last Name
DOB
Address
City
State
Zip
Phone
Email
Hebrew School Program
Grade Entering
Kindergarten
First
Second
Third
Fourth
Fifth
Sixth
Seventh
Hebrew Reading Proficiency
None
Somewhat
Strong
Preview Jewish Education
Yes
No
Is the Biological Mother Jewish?
Yes
No
Have there been any conversions or adoptions in the family?
Yes
No
AS THE PARENT(S) OR LEGAL GUARDIAN OF THE ABOVE CHILD, I/WE AUTHORIZE ANY ADULT ACTING ON BEHALF OF ONE LEV HEBREW SCHOOL 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, ONE LEV HEBREW SCHOOL 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 ONE LEV HEBREW SCHOOL ACTIVITIES AND THAT THESE PICTURES MAY BE USED FOR MARKETING PURPOSES.*
I accept
Payment
*For weekly price: $59 + $12 (dinner)
*No refunds for absences
PAYMENT GUIDELINES:
*If you choose to pay a specific donation, please kindly choose "Other"
*If you choose to pay by check, please kindly mail it to: 523 North Maple Drive, Beverly Hills, CA 90210.
*If you selected a payment method other than credit card, please disregard the credit card information section below.
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