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ב"ה

Youth Programs Hebrew School To You

Hebrew School to You Re-enrollment Form

Student Information:
Child 1*
First NameLast Name
School Currently Attending:*
Grade*
Child 2
First NameLast Name
School Currently Attending:
Grade
Child 3
First NameLast Name
School Currently Attending:
Grade
Please inform us if you have moved or there were any changes to your contact info or if your child has any allergies or any other concerns that we should be aware of:
Classes are held at the location and time of your choice
Payment Information:
Group Lessons (3+ students for one hour a week)
$150 per student per 6-week session

Group Lessons (3+ students for one and a half hours a week)
$225 per student per 6-week session
I would like to register for the following amount of weekly hour long sessions:*
One 6 week session ($150)Two 6 week sessions ($300)Three 6 week sessions ($450)Four 6 week sessions ($600)Five 6 week sessions ($750)None
I would like to register for the following amount of weekly one and a half hour long sessions:*
One 6 week session ($225)Two 6 week sessions ($450)Three 6 week sessions ($675)Four 6 week sessions ($900)Five 6 week sessions ($1125)None
Select Payment plan:*
Pay in FullThree payments
Total:
$0.00

Payment:

Credit Card Paypal

Postal / Zip Code

Country

Should be Empty:

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