Torah Time Registration

Address:

Date of Birth:*
MonthDayYear
Hebrew Name:
Hebrew Birthday if known:
School Currently Attending:
Grade Entering:
Parent Information:
Parent 1 Name:
Home Phone Number:
Area CodePhone Number
Work Phone Number:
Area CodePhone Number
Cell Phone Number:
Area CodePhone Number
Parent 2 Name:
Work Phone Number:
Area CodePhone Number
Cell Phone Number:
Area CodePhone Number
Emergency Contact Info:
Full Name of Emergency Contact:*
First NameLast Name
Emergency Contact Phone Number:*
Area CodePhone Number
Relationship to child:
Pediatrician Name:
Pediatrician Phone Number:
Area CodePhone Number
Allergies?
Permissions:*
Torah Time has permission to adminster first aidIf the need arises, and parents or emergency contacts cannot be reached, Torah Time has permission to have my child transported and treated at an appropriate medical facility.
Registration & Payment Information:
Torah Time tuition is $600 annually. You may pay $67 per month for 9 months or make a one time payment of $600.
Registration Options:*
I would like to pay tuition in full today: $600I would like to pay $67 per month for 9 months.
Total:
$0.00

Payment:

Credit Card

Billing Address

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Country

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Student Information: