Shenzhen Hebrew School Registration Form

Child 1
Student Name

First NameLast Name
Hebrew Name
Age
Birth Date

MonthDayYear
Gender
Does you child read basic Hebrew?
Does your child speak/understand Hebrew?
Does your child have previous Jewish Education
If yes, please describe
Child 2
Student Name

First NameLast Name
Hebrew Name
Age
Birth Date

MonthDayYear
Gender
Does you child read basic Hebrew?
Does your child speak/understand Hebrew?
Does your child have previous Jewish Education
If yes, please describe:
Parent Information
Father's Name

First NameLast Name
Cell Phone
Format: (000) 000-0000.
Home Phone
Format: (000) 000-0000.
Office Phone
Format: (000) 000-0000.
E-mail
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Mother's Name

First NameLast Name
Cell Phone
Format: (000) 000-0000.
Home Phone
Format: (000) 000-0000.
Office Phone
Format: (000) 000-0000.
E-mail
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Are the natural parents of the child (ren) Jewish?
Were there any conversions or adoptions in your family history
If yes, please explain:
Emergency Contact Information
Please list two contacts to be used in case of emergencies
Emergency Contact (other than parent)
Relationship to child
Cell Phone
Format: (000) 000-0000.
Home Phone
Format: (000) 000-0000.
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Contact 2
Emergency Contact (other than parent)
Relationship to child
Cell Phone
Format: (000) 000-0000.
Home Phone
Format: (000) 000-0000.
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Child's physician or medical facility
Physician's phone
Format: (000) 000-0000.
Physician's Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
CONFIDENTIAL
As the parent(s) or legal guardian of the mentioned above students, 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.
Tuition Information

The following is a tuition agreement for the Shenzhen 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:
Shenzhen Hebrew School: 480RMB/Semester (8 lessons).
Includes Registration, Supplies, Snack & Yearly Hebrew School family Shabbat dinner.

Discounts:
5% Discount for students registerd before June 2
Payments Plans
Should be Empty:

Child 1

Child 2

Parent Information

Emergency Contact Information