Mitzvat HaLev Registration 2023

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Use this form to enroll in Mitzvat Halev: Chochmat HaLev's B'Mitzva Program for 6th-8th grade families, beginning August 2023.

Student Information

* Student's First and Last Name

* Student's Birthdate

* Student's Grade in Fall 2023

Please Select One6th7th8th

* 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. (Checks are strongly preferred!) If paying by credit card, please include the convenience fee. If paying by check, please write "Mitzvat HaLev" in the notes section.
Mail to:
Chochmat HaLev
2215 Prince Street
Berkeley, CA 94705

* Tuition Payment - $2000

I'll pay now via ShulCloud (credit card)I'll pay via check made out to Chochmat HaLev

Wed, April 24 2024
16 Nisan 5784

Wed, April 24 2024 16 Nisan 5784