Please fill out this form as an initial registration for the ARIEL Bar Mitzvah Club.
Confirmation of acceptance will be acknowledged only after this registration form is reviewed
and an acceptance email is received.

You will need to fill out a separate form for each child when registering online.

Student Information

Student Last Name Student First Name
Does your child have a Hebrew Name? Provide it here
Date of Birth Age Boy Girl

Does your child read basic Hebrew?
None Somewhat Well

Does your child speak/understand Hebrew? None Somewhat Well

Does your child have previous Jewish Education Yes No
If yes, please describe:

What school does your child attend? Grade entering:

Is the biological mother of the child Jewish by birth? Yes No
Were there any conversions or adoptions in your family? Yes No
If yes, please describe:

Any considerations, such as learning disorder or difficulty, the school should be aware of? (Confidential):

Parent Information
Father's Name Email
Home Phone Work Phone Cell Phone
Address City State Zip

Mother Name Email
Home Phone Work Phone
Cell Phone

Address (if different than above) City State Zip
Emergency Contact Information
Please list two contacts to be used in case of emergencies

Emergency Contact (NOT living with you)
Relationship to child Work / Cell
Home Address Home Phone

Additional person authorized to care for child
Relationship to child
Work / Cell

Home Address Home Phone

Child's physician / Doctor or medical facility
Physician's phone
Physician's address

As the parent(s) or legal guardian of the above child, I/we authorize any adult acting on behalf of ARIEL Hebrew School 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, ARIEL Bar Mitzvah Club 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 trip on and beyond school properties and allow my child to be photographed while participating in ARIEL Hebrew School activities.

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Initial here:
ARIEL Bar Mitzvah Club Tuition Agreement

The following is a tuition agreement for ARIEL Bar Mitzvah Club. The agreement explains the tuition fees, payments plans and refund policies. Please read it through carefully. If paying by check or cash, a payment must be submitted to the school office before any child will be permitted to attend classes.

The tuition for the ARIEL Bar Mitzvah Club is $375.00 per year per child.

Choose from the following payment methods:
PLAN A: You will pay the entire amount in full with a check, cash or credit card.

PLAN B: You will pay the annual tuition on a monthly basis by submitting 1 check of $55 and 8 checks of $40.00 each, dated October through May. All checks must be submitted on or before the first day of Bar Mitzvah Club. If a check bounces you will be responsible for the bank fee.

PLAN C: You will use your credit card to pay the tuition on a monthly basis. Your credit card will be charged $55 for the first month, and then it will be billed $46.25 monthly October through May. To pay with a credit card please include your credit card number and expiration date at the bottom of this page. You will be redirected to another webpage to submit a payment.

If you chose to pay with a credit card, you will be provided with a link to process the payment securely after you submit this form.
Refunds for children withdrawing from school before the end of the school year will be pro-rated up to February 1 provided that the school office is given 30 days written notice. Tuition refunds will not be granted to children withdrawing from school after February 1. There are no refunds or credits for days missed due to illness, holidays, or family vacations.

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Your FULL name here:
Email address to receive the submission confirmation:
I heard about the ARIEL bar Mitzvah Club from: