Hebrew Culture Club

My child is in*

BURR INTERMEDIATE SCHOOLSAWMILL INTERMEDIATE SCHOOL
Dates for Burr
September 8, 2026
October 13, 2026
November 10, 2026
December 8, 2026
January 12, 2027
February 9, 2027
March 16, 2027
April 13, 2027
May 11, 2027
June 8, 2027
Dates for Sawmill
September 15, 2026
October 20, 2026
November 17, 2026
December 15, 2026
January 19, 2027
February 23, 2027
March 23, 2027
April 6, 2027
May 18, 2027
June 15, 2027
Parent's Info
Mother's Name*
First Name Last Name
Mother's Hebrew Name
Mother's E-mail*
Mother's Phone Number*

Area Code Phone Number
Father's Name
First Name Last Name
Father's Hebrew Name
Father's E-mail
Father's Phone Number

Area Code Phone Number

Address*

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Child's Info
How many child(ren)?
Child's Name
First Name Last Name
Child's Hebrew Name
Gender

MaleFemale
Birth Date

Month Day Year
Age
What grade are they entering in the fall?
Any considerations such as learning difficulty's at school we should be aware of (Confidential)
(2) Child's Name
First Name Last Name
(2) Child's Hebrew Name
(2) Gender

MaleFemale
(2) Birth Date

Month Day Year
(2) Age
(2) What grade are they entering in the fall?
(2) Any considerations such as learning disorders or difficulty at school we should be aware of (Confidential)
(3) Child's Name
First Name Last Name
(3) Child's Hebrew Name
(3) Gender

MaleFemale
(3) Birth Date

Month Day Year
(3) Age
(3) What grade are they entering in the fall?
(3) Any considerations such as learning difficulties at school we should be aware of (Confidential)
Emergency Contact
Full Name*
First Name Last Name
Phone Number*

Area Code Phone Number
Relationship to Child(ren)*
Other - Relationship to Child(ren)*
*

By registering, I acknowledge and give consent for photos of my child(ren) to be taken during Hebrew Culture Club and shared on social media for promotional purposes.
Schedule
How often will your child attend the HCC?*

Select specific months ($10 per month)All 10 Months ($75)
How often will your child attend the HCC?*

Select specific months ($10/month per child)All 10 Months ($75 per child)
How often will your child attend the HCC?*

Select specific months ($10/month per child)All 10 Months ($75 per child)
Which months will your child(ren) be attending?*

September 8, 2026October 13, 2026November 10, 2026December 8, 2026January 12, 2027February 9, 2027March 16, 2027April 13, 2027May 11, 2027June 8, 2027
Which months will your child(ren) be attending?*

September 15, 2026October 20, 2026November 17, 2026December 15, 2026January 19, 2027February 23, 2027March 23, 2027April 6, 2027May 18, 2027June 15, 2027
Which months will your child(ren) be attending?*

September 8, 2026October 13, 2026November 10, 2026December 8, 2026January 12, 2027February 9, 2027March 16, 2027April 13, 2027May 11, 2027June 8, 2027
Which months will your child(ren) be attending?*

September 15, 2026October 20, 2026November 17, 2026December 15, 2026January 19, 2027February 23, 2027March 23, 2027April 6, 2027May 18, 2027June 15, 2027
Which months will your child(ren) be attending?*

September 8, 2026October 13, 2026November 10, 2026December 8, 2026January 12, 2027February 9, 2027March 16, 2027April 13, 2027May 11, 2027June 8, 2027
Which months will your child(ren) be attending?*

September 15, 2026October 20, 2026November 17, 2026December 15, 2026January 19, 2027February 23, 2027March 23, 2027April 6, 2027May 18, 2027June 15, 2027
Total

$0.00

Payment*

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Parent's Info

Child's Info

Emergency Contact

Schedule

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