Register

Student Information:
Full Name:*
First Name Last Name
Hebrew Name:
First Name Last Name
Birth Date:*

Month Day Year
Previous School:*
Grade Entering:*

Address:*

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

Parents Information
Father's Name:*
First Name Last Name
Is Father Jewish?

YesNo
Father's Cell:*
Mother's Name:*
First Name Last Name
Mother's Hebrew Name:
Is Mother Jewish?*

YesNo
Mother's Cell:*
Is Maternal Grandmother Jewish?*

YesNo
Were there any conversions or adoptions in the family?*

YesNo
If Yes, Please elaborate:
I am willing to assist in school activities, please contact me
Emergency Info
Emergency Contact #1:*
First Name Last Name
Phone Number*
Emergency Contact #2:*
First Name Last Name
Phone Number*
As the parent(s) or legal guardian of the above child, I/we authorize any adult acting on behalf of Penn Wynne 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, Penn Wynne 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 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 Penn Wynne Hebrew School s and that these pictures may be used for marketing purposes.
I Accept

Yes
Full Name*
First Name Last Name
Payment:
No one will be turned away from Hebrew School due to financial issues. Please call Rabbi Brennan if a payment plan or scholarship is necessary. A payment plan MUST be in place before the school year starts.
Registration Fee:*

One time payment - $900Monthly - $90
Total

$0.00

Payment

Credit Card Other

Postal / Zip Code

Country

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Educate Your Child... Educate a Generation

Student Information:

Parents Information

Emergency Info

Payment:

No one will be turned away from Hebrew School due to financial issues. Please call Rabbi Brennan if a payment plan or scholarship is necessary. A payment plan MUST be in place before the school year starts.