Hebrew School Registration

Student Information
Full Name*
First NameLast Name
Hebrew Name*
Birth Date*Help us find out your child's Hebrew birthday
MonthDayYear
School*
Additional Notable InformationPlease let us know of any other important information that you would like us to be aware of.
Parent Information
Father's Name*
First NameLast Name
Father's Cell*
Area CodePhone Number
Father's E-mail*
Mother's Name*
First NameLast Name
Mother's Cell*
Area CodePhone Number
Mother's E-mail*
Is there any convertion or adoption in the family?*
YesNo
If yes, please elaborate. (all information will be kept confidential)
Emergency Information
Emergency Contact*
First NameLast Name
Relationship*
Phone Number*
Area CodePhone Number
Please list any allergies or medications that the child is taking
Doctor*
First NameLast Name
Doctor's Phone Number*
Area CodePhone Number
Medical Insurance*
Policy #*
Authorization
I give permission to Aleph Hebrew School at MSC, and those authorized by Manhattan Sepharadic Congregation and Aleph Learning Center, to take photographs and to make recordings of my children and my family, and to use them in original or modified form in all media now or hereafter known, with or without my name or information about me, for the promotion, public education, and/or fundraising activities of Aleph Learning Center and/or Manhattan Sepharadic Congregation.
As the parent(s) or legal guardian I/we authorize any adult acting on behalf of the Hebrew After-School Program at MSC 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, the Hebrew After-School Program personnel will try, but are not required, to communicate with me prior to such treatment.
*
I authorize all that is written above
Signature*Full name
Payment
$360

Payment

Credit Card

Credit Card Type
Credit Card Number	Security Code
Name on Card
Expiration Month	Expiration Year

Billing Address

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Country

Thank you for applying! Please note that all applications will be reviewed and acceptance is only confirmed after receiving an acceptance letter.
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Bar Mitzvah Program Registration

Student Information

Parent Information

Emergency Information

Authorization

Synagogue Services

Adult Education

Youth Programs

Holiday Celebrations

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