CHILD INFORMATIONName English Hebrew Grade Entering (Sept 2024): Parent's Email Has your information changed from last year? Yes No Check yes if all Parental information is included on membership forms or past Village Hebrew registration forms (Note: If any changes then what was previously submitted – please complete this form) Yes No Father's Name First Last EMERGENCY INFORMATIONPlease list two contacts to be used in case of emergencies (other than your home and business numbers).Emergency Contact #1: Relationship Home Phone: Work Phone Mobile Phone Emergency Contact #2: Relationship Home Phone: Work Phone Mobile Phone OTHER PERSONS AUTHORIZED TO PICK UP YOUR CHILDName Relationship Home Phone: Work Phone Mobile Phone I/we authorize any adult acting on behalf of Village Hebrew 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, Village Hebrew 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 Village Hebrew activities.Digital signature of parent/legal guardian Date MM slash DD slash YYYY I was referred to Village Hebrew by I would love to volunteer and take a position as a Class Mom, Birthday packages or Individual HS Event committee. (Not all require volunteering on Village Hebrew slotted days and times) Yes No Digital Signature I/We understand that the Family Shabbat Dinner and the End of the Year Celebration are mandatory events. Dates will be provided with our Village Hebrew calendar at the start of the year. The best compliment is a referral. Please suggest a family that would appreciate an invite to our future programs:Name First Last PhoneEmail The primary objective of my child’s Hebrew School experience is toTUITION AGREEMENTThe following document is a tuition agreement with Village Hebrew. The agreement explains the tuition fees, payment plans and refund policies. Please read it through carefully and sign it on the line below. You will receive an acceptance letter including all schedule and class information upon receipt of the signed tuition agreement along with full payment. The tuition for Village Hebrew is as follows: Tuition fee per child for the year: $1,200.00 Registration & Book fee per child: $100 Security fee: $200 per childPOLICIES PLAN A: You may pay the entire amount in full with a check, cash or credit card enclosed with your registration forms. PLAN B: you may split total payment equally into two payments. First installment is due prior to the first day of Hebrew School with your registration forms. The second installment must be submitted as a post dated check or credit card (December 1, 2024) with the return of this form. You may choose from the following payment methods:If you require an alternate payment plan, please contact Village Hebrew Rabbi: Rabbi Cohen 631-585-0521 A student that is becoming a Bar/Bat mitzvah in the current Village Hebrew year of 2024/2025 must be paid in FULL prior to the start of Hebrew School. (PLAN A ONLY). $100 off tuition per student fully registered by June 3, 2024. There are no refunds or credits for days missed due to illness, holidays or family vacations.I will be paying the deposit of $100 and the yearly tuition by Credit Card (3% SURCHARGE WILL BE PROCESSED AT TIME OF CC PAYMENT) Cash or Check Card Number Card Holder's Name Expiration Date Security Code Δ
