The Fraida-Cameron RSF Hebrew School of the Arts!

Student Information:

Full Name*

First NameLast Name

Hebrew Name

Date of Birth*

MonthDayYear

School*

Grade Entering*

Previous Jewish Education

Where?

Please select which track your child will be attending:*

Grades K-1Grades 2-6Bar Mitzvah LessonsBat Mitzvah Lessons

Parent Information:

Father's Name*

First NameLast Name

Father's Phone Number*

Area CodePhone Number

Father's E-mail*

Is father Jewish?

Mother's Name*

First NameLast Name

Mother's Phone Number*

Area CodePhone Number

Mother's E-mail*

Is mother Jewish?

Emergency Information:

Emergency Contact 1*

Phone Number*

Area CodePhone Number

Emergency Contact 2*

Phone Number*

Area CodePhone Number

Doctor*

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.

Payment Information:

Hebrew School Registration:*Includes Textbooks and Supplies

Full Payment $150010 Monthly Installments $150/month (Sep-June)Returning Student Discount: $1200

Please consider an added donation to our scholarship fund

Total

$0.00

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Payment*

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Name on Card
Expiration Month	Expiration Year

Billing Address

Street Address

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City

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Authorization:

Transport / Emergency Care as listed above Authorization:

I hereby give permission for my child to be transported to and from field trips, and to participate in them in all RSF Hebrew School activities. I understand that during the course of RSF Hebrew School my child can be hurt. I accept the risk of possible injury and authorize any member of the Chabad RSF Hebrew School staff to render any necessary first aid. Furthermore, in an emergency case, I hereby authorize Devorah Raskin, Rabbi Levi Raskin or another staff member to have my child taken care of by a physcian or other medical person in any way the situation calls for.

Transport / Emergency Care as listed above Authorization*

I give permissionI don't give permission

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