Register for Wednesday Virtual Hebrew School

We are currently accepting applications for the 2020-21 school year. Please fill out ALL fields of this form. You can register online and mail your check: Please print this form and include it with your check payable to The Shul of Bellaire. If you have any questions or concerns you'd like to discuss, please contact us.

Please note that one registration form per child is required. We look forward to a wonderful year of learning and growth. 

STUDENT INFORMATION
First Name   Last Name
Hebrew Name   D.O.B.

Grade Entering   Exact Time of Birth
      City of Birth
Knowledge of Basic Judaism None Somewhat Well
Hebrew Reading Does not read Hebrew Recognizes letters of the Aleph-Bet Can read Hebrew slowly Can read Hebrew well


PARENT INFORMATION
Father's Name   Father's Cell
Mother's Name   Mother's Cell
Address   City, State, Zip
City State Zip
Home Phone   Email
Were there any conversions or adoptions in the family? Yes No
If yes, please explain:


GETTING TO KNOW YOU
Please answer the following questions to help us know about your family and child so that we may best serve your child's needs (returning students may skip this section)
 
Whats your vision for your child's Hebrew School experience:
 
What are the first 5 things that come to your mind when you think of "Judaism"
 
What makes you proudest about being Jewish?
 
If you had a Hebrew School/day school education, please describe your experience:
 
Is there any other information you would like to share about your family?
 
How can we best support you in being part of your child's Hebrew School Education?
 
How would you describe your child?
 
Does your child have any particular hobbies or passions?
 
Has your child had any behavioral or developmental difficulties or challenges in his/her regular school day?
 
Is there any other information you would like to share/ have us know about your child?
         

EMERGENCY INFORMATION
Emergency Contact 1   Phone
Emergency Contact 2   Phone

CONFIDENTIAL: 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.



As the parent(s) or legal guardian of the above child, I/we authorize any adult acting on behalf of 'The Shul of Bellaire' 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 Shul of Bellaire' 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 'Hebrew School' activities and that these pictures may be used for marketing purposes.

I Accept

Name: Initials:

PAYMENT OPTIONS
• Tuition for the Wednesday Virtual Classes is $895.00 per child.

I will pay by check (full amount or in two payments).

Please write and mail check to: The Shul of Bellaire - 5307 Bissonnet St., Bellaire, TX 77401

I will pay by credit card (monthly payment plans available.)
Name on card   Card Type
Charge Amnt.   Card Number
Exp. Date   CVV Code 3 digits on back of card
         



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

100% of the proceeds of this donation or payment benefit The Shul of Bellaire.