APPLY ONLINE Child's Information Last Name First Name Hebrew Name Gender Male Female Date of Birth: Place of Birth: Address City Province Postal Code Home Phone Previous School II. Family Orientation: Mom's Name: Home Address (if Different from the child): Occupation: Bus phone: Business Address: Cell Phone Email: Dad's Name: Home Address (if Different from the child): Occupation: Bus phone: Business Address: Cell Phone Email: Marital Status of Parents: Married Separated Divorced Other Language Spoken at Home: Enrollment Options / Tuition & Fees CHILD IS APPLYING FOR ADMISSION TO: AGE: TODDLER PRESCHOOL DAYS PER WEEK: 2 Days 3 Days 5 Days Hrs Per Day: Short Day (9-1) Long Day (9-2:55) For the Academic year of Beginning in the month of Total Tuition Fee * Application fee ($100.00) will be processed immediately. Registration fee (one months tuition) will be processed after admission has been confirmed. * Please note: A %2 fee will be applied for credit card payments. Payment Information Registration Fee Card Type Visa Master Card Amex Card Number Expiration Date 2014 2015 2016 2017 2018 2019 2020 2021 2022 2023 2024 -Year- -Month- 01 02 03 04 05 06 07 08 09 10 11 12 Security Code Name on Card Billing address Billing Postal code This page uses 128 bit SSL encryption to keep your data secure.