Hebrew High Enrollment Form

Student Name*
Birthday*

Month Day Year
Parent(s) name*
Name of school*
Name of Counselor*
Father is Jewish?*

YesNo
Mother is Jewish?*

YesNo
Parents E-mail*
Parents Phone Number*

Area Code Phone Number

Home Address*

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

Payment Options*

Pay Upfront - $1875Pay in 10 Monthly Increments of $187.50I Have a Scholarship
Your Scholarship Price*

$
Total Due Today

$0.00

Payment* For discounts call 714-828-1851. The Hebrew High program partners with the Passport Program for Jewish Life all requests must be in before June 6th

Credit Card Paypal

Postal / Zip Code

Country

Should be Empty:

This page uses TLS encryption to keep your data secure.

Hebrew High Enrollment Form

Synagogue Services

Hebrew High

Seal Beach Menorah

Ethel's Chicken Soup Program

Women's Events

Sponsor a Mitzvah!