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Shul House (Kindergarten-Grade 7)

Welcome to Shul House, where Jewish learning feels like home!

For questions please email Margaret Barcohana or call 631-324-9858.

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Name (Parent/Guardian 1)(Required)

First Name Last Name

Phone (Parent/Guardian 1)(Required)

Email (Parent/Guardian 1)(Required)

Name (Parent/Guardian 2)

First Name Last Name

Phone (Parent/Guardian 2)

Email (Parent/Guardian 2)

Mailing Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Local Address (if different from Mailing Address)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Security Assessment (Family) Non-Member(Required)

Semester 1 ($250)

Semester 2 ($250)

Both Semesters ($500)

Paid in full for both semesters ($0)

Name (Student 1)(Required)

First Last

Grade (Student 1)(Required)

Date of Birth (Student 1)(Required)

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Allergies (Student 1)

Semester (Student 1) Member(Required)

Semester 1 ($500)

Semester 2 ($500)

Both Semesters ($1,000)

Semester (Student 1) Non-Member(Required)

Semester 1 ($750)

Semester 2 ($750)

Both Semesters ($1,500)

Name (Student 2)

First Last

Grade (Student 2)

Date of Birth (Student 2)

MM slash DD slash YYYY

Allergies (Student 2)

Semester (Student 2) Member

Semester 1 ($500)

Semester 2 ($500)

Both Semesters ($1,000)

Semester (Student 2) Non-Member

Semester 1 ($750)

Semester 2 ($750)

Both Semesters ($1,500)

Name (Student 3)

First Last

Grade (Student 3)

Date of Birth (Student 3)

MM slash DD slash YYYY

Allergies (Student 3)

Semester (Student 3) Member

Semester 1 ($500)

Semester 2 ($500)

Both Semesters ($1,000)

Semester (Student 3) Non-Member

Semester 1 ($750)

Semester 2 ($750)

Both Semesters ($1,500)

List two (2) persons who may be called in case of emergency(Required)

Name

Phone

Relationship

CHILD WILL BE RELEASED ONLY TO THESE PERSONS

It is understood that in the final disposition of an emergency case, the judgment of the school authorities will prevail. The recommendation of the parent as indicated above will be respected as far as possible.

Photo Opt-out

Opt-out

By checking this box, I hereby exercise my right to opt-out and request that my child's photograph not be used or published in any promotional material, including but not limited to school publications, websites, social media channels, and other forms of public representation.

Payment

Payment Options(Required)

I would like to pay in full by credit card.

Please send me an invoice so I may pay by check.

Please contact me to set up a payment plan.

Please contact me to discuss financial assistance.

I would like to attend a trial.

Please consider a 3% donation to offset credit card processing fees

Yes, I wish to donate 3% to offset credit card processing fees

3% to offset credit card processing fees

Price: $0.00

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Supported Credit Cards: American Express, Discover, MasterCard, Visa

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Expiration Date Month Year

Security Code Cardholder Name

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No child will be denied the opportunity to participate and learn due to financial constraints. To arrange a payment plan, or if you require financial assistance, please email office@jcoh.org or call 631-324-9858. All arrangements will be made in the strictest confidence.

Jewish Center of the Hamptons | East Hampton, NY 11937 | 631‑324‑9858

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