Religious School Registration 2018-2019

Registration 2018-2019
Welcome to our new online school registration form. This form allows you to register BY FAMILY. Contact Lauren Chizner, school@portjewishcenter.org or 516-817-9576, with any questions.

FAMILY INFORMATION

* New / Returning Family

* Parent #1 Last Name

* Parent #1 First Name

* Relationship to Student(s)

Parent #1 Work Phone

* Cell Phone

* Parent #2 Last Name

* Parent #2 First Name

* Relationship to Student

* Home Address for Student(s)

* City, State, Zip

* Home Phone

* May we take & use your child(ren)'s photo?

YES, for any useNO, not for any use

* Emergency Contact Information

Please provide the name and number of a local friend or family member who can be contacted in the case of emergency (if both parents are unreachable).

STUDENT INFORMATION

* Student #1 First Name

* Last Name

* Grade

Hebrew Name

* Date of Birth

MM/DD/YY

* Public School

T-Shirt Size

Child's Doctor

Name and phone number

Allergies or medical conditions

Please provide any additional information about your child regarding learning, social, or behavior issues that will help us offer the best possible school experience:

If no more children skip to next section

Student #2 First Name

Student #2 Last Name

* Grade

Student #2 Hebrew Name

* Date of Birth

MM/DD/YYYY

Public School

T-Shirt Size

Child's Doctor

Name and Phone Number

Allergies or medical conditions

Please provide any additional information about your child regarding learning, social, or behavior issues that will help us offer the best possible school experience:

If no more children skip to the next section

Student #3 First Name

Student #3 Last name

Grade

Hebrew Name

Date of Birth

mm/dd/yy

Public School Grade

T-Shirt Size

Child's Doctor

Name and Phone Number

Allergies and Medical Conditions

Please provide any additional information about your child regarding learning, social, or behavior issues that will help us offer the best possible school experience:

If no more children skip to the next section

Student #4 First name

Student #4 Last name

Hebrew Name

Date of Birth

mm/dd/yy

Public School grade

T-Shirt Size

Child's Doctor

Name and Phone Number

Allergies and Medical Conditions

Please provide any additional information about your child regarding learning, social, or behavior issues that will help us offer the best possible school experience:

TUITION

Kindergarten: No Charge

1st Grade: $300

2nd grade: $375

Grades 3-6: $650

Grade 7: $600

Hebrew High (Grades 8-10): $525

15% discount for families with 2 or more students (in Grades 1-10).

Total

Thu, April 18 2024 10 Nisan 5784