CPLC Registration Form

Registration Form

Tuition for grades 1-12: $1800 per month

Registration fee is $100.

If you would like to apply for a scholardhip, please fill out this form.

10% of applicants will receive a full scholarship.

Your (parent) info

First Name *

Last Name *

Email *

Mobile Phone Number *

I am the child's *

Street Address *

City *

State/Province *

Postal Code *

Parent 2

Your relationship to Parent 2 *

First Name *

Last Name *

Email *

Mobile Phone Number *

Parent 2 is the child's *

Does Parent 2 reside at the same home address as Parent 1?

Yes

Street Address

City

State/Province

Postal Code

Child Info

First Name *

Last Name *

Birth Date *

Month

Day

Year

Birth Date Before Sunset? *

Yes

Unknown

This information is necessary to calculate your child' Hebrew birthday. If you don't know the answer, put unknown.

Child lives at the same address as parent 1? *

grade your child is currently in *

grade your child is getting into *

Child's previous school *

Name of siblings and their ages *

Name of school(s) that siblings attend *

Does your child have an IEP? *

Does your child have any allergies? please explain *

Does your child take any medication during school hours? *

Yes

Please list medications and dosage *

Second contact info in case of emergency *

Doctor name and number *

Dentist name and number *

I give permission for my child to participate in field trips. I understand that my child will be under the care and direction of the Bais Bezalel Learning Center, and I will be notified in case of an emergency. *

Will you be requiring financial assistance? *

I grant Bais Bezalel Learning Center permission to take pictures and videos of my child *

If your child has an IEP, please upload here