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Norwich Hebrew School Registration

Student Information
Full Name*

First Name Last Name
Hebrew Name
Birth Date

Month Day Year
School
Previous Jewish Education
Grade entering

Address

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

Parents Information
Father's Name

First Name Last Name
Father's Cell

Area Code Phone Number
E-mail*
Mother's Name

First Name Last Name
Mother's Cell

Area Code Phone Number
E-mail*
Is Father Jewish?

YesNo
Is Mother Jewish?

YesNo
Have there been any conversions or adoptions in the family?

YesNo
If yes, please specify
Emergency Information
Does your child have any allergies or medical condition we should be aware of? Please specify
Emergency contact
Phone Number
As the parent(s) or legal guardian of the above child, I/we authorize any adult acting on behalf of Norwich 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, Norwich Hebrew School personnel will try to communicate with me prior to such treatment.
Parent Signature* Type your name
I allow my child to be photographed while participating in Norwich Hebrew School activities and that these pictures may be used for marketing purposes.
Parent Signature Type your name
Tuition fee for Norwich Hebrew School 2024-25

$650
Tuition Payment Options*

$650 Full Payment of tuition with registration$325 with registration and the balance of $325 to be paid by December 1st 2024Please contact me to discuss scholarships and other payment plans
Total

$0.00

Payment

Credit Card Check

Postal / Zip Code

Country

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