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ב"ה

REGISTRATION

A vibrant Jewish after-school program

Child's Information
Child's Name*
First NameLast Name
Birth Date*
MonthDayYear
Current School Attending (2021/22)*
Grade*
Siblings
Does your child have any allergies or other medical conditions we should be aware of? If yes, please describe them and indicate special precautions or care needed.
Please tell us a little bit about your child!
Parent Information
Father's Name
First NameLast Name
Father's E-mail
Father's Cell
Area CodePhone Number
Mother's Name
First NameLast Name
Mother's Email
Mother's Cell
Area CodePhone Number

Full Home Address*

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

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As the parent(s) or legal guardian of the above child, I/we authorize any adult acting on behalf of Palm Beach Hebrew to hospitalize or secure treatment for my child in case of emergency. 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 Palm Beach Hebrew’s activities and that these pictures may be used for marketing purposes.
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2022 Tuition
$1000
Optional Sponsorship
$10000$5000$1800.00

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