Full Name

Hebrew Name

Age Birth Date

Hebrew Birthday

Grade Entering School Attending

Does your child have any allergies?

if so, please list them

Any previous Jewish education?

if so, please explain


Home Address

City Zipcode

Home #

Family Email

please use an email that is checked frequently

Father's Name Cell #

Mother's Name Cell #

Is the Natural Mother of the child Jewish?

If the answer to the above question is no, please explain:


Contact Name Phone

Contact Name Phone

As the parent(s) or legal guardian of the above child, I/we authorize any adult acting on

behalf of the Westside 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, the Westside 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 the Westside Hebrew School activities and

that these pictures may be used for marketing purposes.

I Accept

Name: Initials:


Hebrew School will run weekly from September 2015 through the beginning of June 2016.

Choose one option:

Sunday Classes - Annual Tuition: $800 (snacks and supplies included)

Annual Tuition will be paid by:

Plan A - I will give in up to 10 head checks to be deposited monthly,

made payable to the Westside Hebrew School

Plan B - I will pay by Credit Card

Please charge my credit card for the amount of


One-time Full Payment Monthly Payment

If you have any other questions regarding payment you must speak

with Brocha before School begins. 310-271-6193 ext. 108

Refunds for withdrawing children from school before the end of the school year will be granted provided that the school is given 30 days written notice. Tuition refunds will not be granted after April 1st. A limited number of scholarships are available upon request; no child will be turned away for lack of funds.


►For 2nd sibling receive 5% off , 3rd sibling 5% off etc.

►Refer a friend (that has never been to our Hebrew School)

and receive $25 off when they register for Hebrew School!


We look forward to a wonderful year of learning and growth!