Ezra-Habonim, the Niles Township Jewish Congregation

4500 Dempster,

      Phone#:(847)675-4141 or Fax#:(847)675-0327

Must be members of the synagogue to be eligible.

All information on this form is confidential with the exception of name, address, phone which will be added to our School Directory.

PLEASE PRINT OR TYPE:

Child’s Full Name:_______________________________________________________________

Hebrew Name:__________________________________________________________________

(Check here if you want a Hebrew name for your child)__________

Grade in School as of September 2008:_________Name of School: _________________________

Date of Birth:______/________/________

Did your child attend

last year?______________

If not, what school did your child attend:______________________________________________

                                                                Name                                                                       Location

Mother’s Name:__________________________________________________________________

Father’s Name:__________________________________________________________________

Family Address:__________________________________________________________________

                         Street                                                      City                                       State                              Zip

Family Address:__________________________________________________________________

                             Street                                                      City                                        State                              Zip

Family Phone:___________________________________________________________________

Parent’s Work Phone:_____________________________________________________________

                                    Mother                                                                                     Father

Parent’s E-Mail:__________________________________________________________________

                                        Mother                                                                                     Father

Emergency Contact:___________________________________________Phone:_____________

Relation to Child:_________________________________________________________________

Emergency Contact:__________________________________________Phone:______________

Relation to Child:_________________________________________________________________

Child’s Special needs and interests: 

Please indicate everything you feel we need to know.  Allergies, learning disabilities, etc. (only the rabbi and teacher of child will see this)

Use additional paper, if necessary.

Persons other than parents/guardians authorized

To pick up student:

Name:_______________________________________________________Phone:____________

Name:_______________________________________________________Phone:____________

Names of Grandparents if members of EHNTJC:_______________________________________

______________________________________________________________________________

I give Ezra-Habonim, the Niles Township Jewish Congregation, its employees and representative’s permission to photograph my child taking part in synagogue activities, whether on synagogue grounds or off.

______________________________________________________________________________

Signature of Parent or Guardian

Religious School Tuitions & Fees:          2008/5769 on-site School

Saturday School Only              Grades K-2       $220 tuition      +          $40 supply fee

Hebrew School                         Grades 3-7        $630 tuition      +          $80 supply fee

Lehrhouse (Tuesday Night)      Grades 8-10      $360 tuition      +          $40 supply fee

B’nai Mitzvah (must be paid in full before event              $1,000

Discounts:

2^nd child in the school:  Family receives 10% discount off the lowest tuition.

            3^rd child in the school:  Family receives 15% discount off the lowest tuition.

            No discounts on supply fees.