Aleph Afterschool Club Registration Form

Aleph Afterschool Club Registration 2024-2025

Please fill out all fields in this form (one for each child). If you have any questions or concerns please contact us at [email protected]
Student one Profile
First Name
Last Name
Hebrew Name
Birth Date

Month Day Year
School
Grade Entering
How would you rate their Hebrew reading proficiency?

NoneSomewhatWell
How would you rate their general knowledge of Jewish concepts and ideas?

Not FamiliarSomewhat familiarVery Familiar
Has your child had previous Jewish Education?

YesNo
If yes, where?
Does your child have any allergies or other medical condition we should be aware of? If yes, please describe them and indicate special precautions or care needed
Does your child have any learning diffrences? What can we do to help them succeed?
Student Two Profile
Would you like to register a 2nd child?

Yes (or leave blank if no)
First Name*
Last Name*
Hebrew Name*
Birth Date*

Month Day Year
School*
Grade Entering *
How would you rate their Hebrew reading proficiency?*

NoneSomewhatWell
How would you rate their general knowledge of Jewish concepts and ideas?*

Not FamiliarSomewhat familiarVery Familiar
Has your child had previous Jewish Education?*

YesNo
If yes, where?*
Does your child have any allergies or other medical condition we should be aware of? If yes, please describe them and indicate special precautions or care needed*
Does your child have any learning diffrences? What can we do to help them succeed?*
Parent Information
Father's Name

First Name Last Name
Father's Occupation
Is father Jewish?
Father's E-mail
Father's Phone Number

Area Code Phone Number
Mother's Name

First Name Last Name
Mother's Occupation
Is mother Jewish?
Mother's Email
Mother's Phone Number

Area Code Phone Number

Home address

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

Emergency Contact Info
Emergency Contact #1

First Name Last Name
Relationship to Child
Phone Number

Area Code Phone Number
Emergency Contact #2

First Name Last Name
Relationship to Child
Phone Number

Area Code Phone Number
Payment Information

Tuition is a sliding scale ($620, $720 or $820) Please indicate which plan works best for you and/or if you would like to place a deposit now and be billed at a later date. Our goal is to make Jewish experiences as accessible as possible if you need further financial assistance please do not hesitate to reach out to us.
Pay Now Full Tuition - $820 including deposit
Pay Now Discounted Rate - $720 Including Deposit
Pay Now Scholarship Rate - $620 (including deposit)
Deposit $100 Please bill me for the balance
Please bill me for: (If giving a deposit)
Total

$0.00

Payment

Credit Card

We accept Visa, MasterCard, American Express, Discover
Credit Card Number	Security Code
Name on Card
Expiration Month	Expiration Year

Billing Address

Street Address

City

State / Province

Postal / Zip Code

Country

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Programs

Aleph Afterschool Club Registration Form

Aleph Afterschool Club Registration 2024-2025

Student one Profile

Student Two Profile

Parent Information

Emergency Contact Info

Payment Information

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