2025-2026 WJC Lev Shalem School Registration Form

LEARNER INFORMATION

* First Name

* Last Name

* Gender

* Pronouns

* Date of Birth

* Email Address (if applicable)

Phone Number (if applicable)

EDUCATION INFORMATION

* Secular School Name

* Grade in Secular School

* Secular School District

MEDICAL INFORMATION
Enrollment will not be considered complete until we have appropriate and up-to-date vaccination records received by the office.

* Any health condition(s)/allergies/dietary restrictions?

* Any medications we should know about?

* Please list health condition(s)/allergies/dietary restrictions below

* Please list medications below

LEARNING INFORMATION

* We are committed to creating an inclusive learning environment. Please share any and all helpful information about this learner so that we can best support them in a successful year. If you are more comfortable meeting to discuss this, please indicate below.

* Please describe the learner's experience and comfort level with Hebrew.

2025-2026 LEV SHALEM ENROLLMENT REGISTRATION

* Learner Enrollment Options

Lev Shalem Students Only (n/a to Youngsters or Be a Mitzvah)

Private lessons recommended for all students; required for all students ages 11 and up.

EMERGENCY INFORMATION

In case of emergency, we will contact the Parent(s) listed first. If there are ADDITIONAL Emergency Contacts, please list them below.

EMERGENCY CONTACT 1

Full Name

Phone Number

Relationship to the Learner

EMERGENCY CONTACT 2

Full Name

Phone Number

Relationship to the Learner

DOCTOR INFORMATION

* Primary Healthcare Provider

* Primary Healthcare Provider Phone Number

EMERGENCY WAIVER

* In the event that no one can be reached, I/we give permission for the staff of WJC to take whatever emergency measures are necessary.

Please Select an OptionYesNo

PARENT/GUARDIAN INFORMATION

* Is there more than one Adult in your household?

PRIMARY PARENT/GUARDIAN

* First Name

* Last Name

* Email

* Phone Number

* Relationship to Learner

SECONDARY PARENT/GUARDIAN INFORMATION

First Name

Last Name

Phone Number

Relationship to Learner

ADDITIONAL PARENT/GUARDIAN INFORMATION

* Is there an Additional Parent/Guardian to add?

First Name

Last Name

Mobile Phone

Relationship to Learner

MEDIA RELEASE

* Media Release: Photos and video are often taken during family school and other shul programs. We would like your permission to use this media on our website, social media, newsletter, and occasionally on flyers and ads or other promotional items. Images will not be identified with any names.

Please Select an OptionYES, I give permissionNO, I DO NOT give permission
Please note you may rescind your release at any time by submitting a written request to the main office.

Parent/Guardian Signature

* Signature

* Today's Date

TOTAL TUITION

Tuition Details

Lev Shalem School

The 2025-2026 tuition for the Lev Shalem School is $700 per student. There is a deposit of $50 upon registration. For all students over 11 and any others who opt in, there is an additional cost of $300 for the bi-weekly private Hebrew tutoring. All Lev Shalem School families are expected to be or become members in good standing to participate in the Lev Shalem School. First year students who are not ready to become WJC members may opt to pay $1000 tuition in lieu of membership for the first year. For families with multiple children, each additional child enrolled receives a tuition discount of 25%. The WJC is committed to cost not being a barrier to Jewish engagement and aspires to remove any barriers to accessing reduced tuition, so if this is not possible for you, please reach out to our Senior Administrator, Tara Nicholson. Enrollment will not be considered complete until we have appropriate and up-to-date vaccination records received by the office.

We will meet on Wednesday evenings from 4:00 PM to 6:30 PM. One week a month, our Wednesday meeting will be replaced by our Saturday Shabbat Chevruta.

Be a Mitzvah Program

Tuition for our Be a Mitzvah program is $1800. This cost covers our biweekly class, weekly private tutoring, and all administrative and clergy preparation for the B Mitzvah day. You are invited to pay in full today or any amount between $50 and $1800. If you choose to pay a portion today — we require a $50 minimum payment — we will bill you for the balance. Enrollment will not be considered complete until we have appropriate and up-to-date vaccination records received by the office.

Lev Shalem Youngsters

The cost of the Lev Shalem Youngsters program is $500. There is a deposit of $50 upon registration. Enrollment will not be considered complete until we have appropriate and up-to-date vaccination records received by the office.

Thank you so much! We look forward to an exciting year together!

PLEASE NOTE: THE TOTAL AMOUNT BELOW IS NOT WHAT YOU ARE EXPECTED TO PAY AT THE TIME OF ENROLLMENT. ON THE FOLLOWING SCREEN, YOU WILL HAVE THE OPTION TO PAY ALL AT ONCE OR IN MONTHLY INSTALLMENTS.

Sun, 31 August 2025

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