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Mitzvat HaLev Registration 2024
Please verify reCaptcha before submitting the form.
Use this form to enroll in
Mitzvat Halev
: Chochmat HaLev's B'Mitzva Program for 6th-8th grade families, for the 2024 - 2025 year.
Student Information
*
Student's First and Last Name
*
Student's Birthdate
*
Student's Grade in Fall 2024
Please Select One
6th
7th
8th
*
Student's Educational Background
What school does the student currently attend? Does the student have any experience reading or speaking Hebrew? Does the student have any prior experience with Hebrew school or private tutoring?
Parent 1 Information
*
Name of Parent/Guardian 1
*
Parent/Guardian 1 Email Address
This email address will receive a confirmation of this registration
*
Parent/Guardian 1 Phone Number
Parent/Guardian 1 Physical Address
Parent 2 Information
Name of Parent/Guardian 2
Parent/Guardian 2 Email Address
Parent/Guardian 2 Phone Number
Parent/Guardian 2 Physical Address
Other Information
*
Student's Medical Insurance Provider and Number
*
Important Medical Info
Please include information regarding allergies, learning disabilities, any medications, or special needs. If the student does not have any, please write N/A.
*
Emergency Contact
Please provide the contact information [Name, Phone Number, and Email Address] of one additional adult to be contacted in the event of an emergency.
*
I understand that by enrolling in Mitzvat HaLev, I am committing to Chochmat HaLev Membership for the duration of the program, plus an additional year, at the Emotion | Yetzirah level ($125/month for a single adult; $240/month for multiple adults) or above.
I understand that by enrolling in Mitzvat HaLev, I am committing to Chochmat HaLev Membership for the duration of the program, plus an additional year, at the Emotion | Yetzirah level ($125/month for a single adult; $240/month for multiple adults) or above.
No one is turned away for lack of funds. Contact shalom@chochmat.org if this is a barrier to your participation.
Payment Information
Please either pay via ShulCloud/credit card OR make a check out to Chochmat HaLev. If paying by check, please write "Mitzvat HaLev" in the notes section.
Mail to:
Chochmat HaLev
2215 Prince Street
Berkeley, CA 94705
*
Tuition Payment - $2100, Materials Fee $100, Total Payment $2200
I'll pay now via ShulCloud (credit card)
I'll pay via check made out to Chochmat HaLev
Fri, May 3 2024
25 Nisan 5784
Fri, May 3 2024 25 Nisan 5784
