Registration 2019- 2020

Parent's Information
Father's Name
First NameLast Name
E-mail
Father's Mobile Number
Area CodePhone Number
Mother's Name
First NameLast Name
E-mail
Mother's Mobile Number
Area CodePhone Number

Home Address

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

Student Information (Child 1)
Student Name
First NameLast Name
Hebrew Name
Birth Date
MonthDayYear
Age
MaleFemale
Does your child read basic Hebrew
NoneSomewhatWell
Does your child speak/understand Hebrew?
NoneSomewhatWell
Does your child have previous Jewish education?
YesNo
If yes, please describe
Student Information (Child 2)
Student Name
First NameLast Name
Hebrew Name
Birth Date
MonthDayYear
Age
MaleFemale
Does your child read basic Hebrew
NoneSomewhatWell
Does your child speak/understand Hebrew?
NoneSomewhatWell
Does your child have previous Jewish education?
YesNo
If yes, please describe
Student Information (Child 3)
Student Name
First NameLast Name
Hebrew Name
Birth Date
MonthDayYear
Age
MaleFemale
Does your child read basic Hebrew
NoneSomewhatWell
Does your child speak/understand Hebrew?
NoneSomewhatWell
Does your child have previous Jewish education?
YesNo
If yes, please describe
General questions
Are the natural parents of the child(ren) Jewish
YesNo
Were there any conversions or adoptions in your family history
YesNo
If yes, please explain
What are the top 2 things you would like your child/ren to gain this year by coming to Pudong Hebrew School? If more than one child - please specify for each one:
Please mention any new and updated information that you feel we should know about your child/ren, or information that you think teachers should be aware of for this upcoming school year.
Emergency Contact Information
Please list two contacts to be used in case of emergencies (other than your home and business numbers).
Emergency Contact 1
First NameLast Name
Phone Number
Area CodePhone Number
Relationship to child
Emergency Contact 2
First NameLast Name
Phone Number
Area CodePhone Number
Relationship to child
Child's physician or medical facility
First NameLast Name
Phone Number
Area CodePhone Number
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.
As the parent(s) or legal guardian of the Children above, I/we authorize any adult acting on behalf of Pudong 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, Pudong 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 attend all field trips and outings with Pudong Hebrew School.
AcceptDo Not Accept
Initial here:
Tuition Information
The following is a tuition agreement for the Pudong Hebrew School. A full payment plan must be submitted to the school office before the school year begins. No child will be turned away for lack of funds.
Tuition fee:
Pudong Hebrew School: ¥5,100 + ¥250 registration & book fee. Includes Registration, Supplies, Snack & Yearly Hebrew School family Shabbat dinner.
Discount:
5% Discount for students registered before August 12.
Payment Plans
Bill me the full payment of ¥5,100 + ¥250 through the credit card given below.I would like to pay the tuition in 5 instalments through the year. Charge my credit card 5 times ¥1,070 of the overall tuition every month, September through January.I will pay the full payment of ¥5,100 + ¥250 cash, before the beginning of the school year.