Register

Home Address

Doctor's Address

Medical Coverage
Insurance Company
Policy Number
AllergiesIf any, please list
Medical ConditionsIf any, please explain
Persons to be contacted in case of an emergency when parents cannot be reached
Full Name
First NameLast Name
Phone Number
Area CodePhone Number
Relationship to child
Full Name
First NameLast Name
Phone Number
Area CodePhone Number
Relationship to child
Permission for Emergency Medical Treatment:
As the parent or legal guardian of the applicant, I authorize any adult acting on behalf of the Brighton Hebrew School to take whatever medical measures they deem necessary for my child in the event of a medical emergency. I further agree to pay for all charges for that care and/or treatment. It is understood that, if time and circumstances reasonably permit, Brighton Hebrew School will try to communicate with me prior to such treatment.
Signature of Parent or Legal Guardian
Date
MonthDayYear
Tuition Information
The following section is a tuition agreement for the F.R.E.E. Hebrew School. The agreement explains the tuition fees and payments plans. Please read it through carefully and sign it below. A limited number of scholarships are available upon request; no child will be turned away for lack of funds .
Tuition for a Hebrew School year is $650 .
We offer a $50 discount on the tuition of each additional child in the family.
This fee does not include extra curricular activities such as trips.
I agree to pay for the school year
$

Payment

Credit Card Check or Cash

Payment OptionsPlease choose one of the following tuition options
Option 1: Prepayment in full by 10/6/2022Option 2: Pay in 2 payments – 10/6/22 and 2/9/23Option 3: Pay in 3 payments – 10/6/22 and 2/9/23 and 5/10/23
Full Name
First NameLast Name
Signature
Date
MonthDayYear
Parental Release
Field Trip/Activity Permission Slip
I give permission for my child to participate in all school activities, and to join in class and school trips on and beyond school properties and use any transportation selected by the Brighton Hebrew School. No additional permission slip will be required throughout the year.
Pictures/Video
I allow pictures or video of my child to be used for Brighton Hebrew School – F.R.E.E. of Brighton Beach advertisement, website or brochure.
Name of child/ren
Signature of Parent
Date
MonthDayYear
If you have any additional questions, please call Rabbi Dovid at 917-754-6942.
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