FALL REGISTRATION 2010...DEADLINE JUNE 30TH

Tuition includes all handouts, snacks and activities. To secure your enrollment, please pay full amount for family membership and/or tuition.

Please make checks payable to:

Hebrew Wizards, Inc.
C/O Morah Deborah Salomon
130 Cummings Point Road
Stamford, CT 06902

Hebrew Wizards Family Application 2011-2011
Contact Person's First Name
Contact Person's Last Name
Contact Person's E-mail Address
Contact Person's Phone Number
Annual Family Membership Fee	$1,000.00
Parent's/Guardian's Details
Click to enter Parent / Guardian 1 Information
Parent / Guardian 1 First Name Last Name E-mail Address Cell Phone Address City State Zip Code
Click to enter Parent / Guardian 2 Information
Parent / Guardian 2   Tick if same address as Parent / Guardian 1 First Name Last Name E-mail Address Cell Phone Address City State Zip Code
Click to enter Emergency Contact Information
Emergency Contact   Tick if same address as Parent / Guardian 1 First Name Last Name E-mail Address Cell Phone Address City State Zip Code
Child Details
Click to enter Child 1 Information
Child 1 Class Please select Mini-Wizards (Ages 4-5) Wizards I (Ages 6-7) Wizards II (Ages 8-12) Mitzvah Wiz (Ages 12-13) Teen Wizards (Ages 13-18) Class Wizards Teen Time (Ages 14-18) First Name Last Name Date of birth Month January February March April May June July August September October November December Day 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Year 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2001 2002 2003 2004 2005 Which school does this child attend?
Click to enter Child 2 Information
Child 2 Class Please select Mini-Wizards (Ages 4-5) Wizards I (Ages 6-7) Wizards II (Ages 8-12) Mitzvah Wiz (Ages 12-13) Teen Wizards (Ages 13-18) Class Wizards Teen Time (Ages 14-18) First Name Last Name Date of birth Month January February March April May June July August September October November December Day 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Year 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2001 2002 2003 2004 2005 Which school does this child attend?
Click to enter Child 3 Information
Child 3 Class Please select Mini-Wizards (Ages 4-5) Wizards I (Ages 6-7) Wizards II (Ages 8-12) Mitzvah Wiz (Ages 12-13) Teen Wizards (Ages 13-18) Class Wizards Teen Time (Ages 14-18) First Name Last Name Date of birth Month January February March April May June July August September October November December Day 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Year 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2001 2002 2003 2004 2005 Which school does this child attend?
Click to enter Child 4 Information
Child 4 Class Please select Mini-Wizards (Ages 4-5) Wizards I (Ages 6-7) Wizards II (Ages 8-12) Mitzvah Wiz (Ages 12-13) Teen Wizards (Ages 13-18) Class Wizards Teen Time (Ages 14-18) First Name Last Name Date of birth Month January February March April May June July August September October November December Day 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Year 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2001 2002 2003 2004 2005 Which school does this child attend?
Click to enter Child 5 Information
Child 5 Class Please select Mini-Wizards (Ages 4-5) Wizards I (Ages 6-7) Wizards II (Ages 8-12) Mitzvah Wiz (Ages 12-13) Teen Wizards (Ages 13-18) Class Wizards Teen Time (Ages 14-18) First Name Last Name Date of birth Month January February March April May June July August September October November December Day 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Year 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2001 2002 2003 2004 2005 Which school does this child attend?
Sponsorship
I would like to sponsor the Wizards Board in the amount of     $0.00 $250 $500 $750 $1000 Or enter amount here $
Total Fees Due
$1000.00
Comments / Special Instructions / Feedback
I am a new family and I have been referred by:
I grant Hebrew Wizards permission to display pictures of my Child on the hebrewizards.com website.
I grant permission to use pictures of my child for promotional materials for Hebrew Wizards including DVD's and YOU TUBE.
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