Printed fromJewishPV.com

Educate your child... educate a generation!

ב"ה

Registration Form

We are currently accepting application forms for the 2020-2021 school year. Please fill out ALL fields of this form. If you have any questions or concerns you'd like to discuss with us, please contact us at 310.544.5544
Please note that one registration form per child is needed.

We look forward to a wonderful year of learning and growth.
STUDENT PROFILE
Students Name*
First NameLast Name
Hebrew NameIf known
Date of Birth*
MonthDayYear
Gender*
BoyGirl
Grade Entering*
Previous Jewish Education*
YesNo
PARENTS INFORMATION
Father Name
First NameLast Name
Jewish by birth*Fathers Jewish Status
YesNo
Father Phone
Area CodePhone Number
Father E-mail
Mothers Name
First NameLast Name
Jewish by birth*Mothers Jewish Status
YesNo
Mother Phone
Area CodePhone Number
Mother E-mail

Address

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

EMERGENCY CONTACT
1 Emergency Contact*
First NameLast Name
Phone*
Area CodePhone Number
Relation to Child*
2 Emergency Contact
First NameLast Name
Phone
Area CodePhone Number
Relation to Child
PAYMENT
The Tuition fee is $800 for the year. There are two payment options.
1. A full payment of $800
2. Four installments of $200

Payments can be made by Credit Card or by Check. If you need financial assistance please choose "Financial Assistance Requested" and we will contact you regarding any scholarship opportunities
Payment Options
Charge my CC Full amountCharge my CC in 4 InstallmentsI'm paying the DepositFinancial Assitance Needed
Total
$100.00

Payment

Credit Card Check

Postal / Zip Code

Country

Should be Empty:

This page uses TLS encryption to keep your data secure.