2026-27 HEBREW PROGRAMS REGISTRATION FORM

Please complete the form below. Required fields marked with an asterisk *

2026-27 HEBREW PROGRAMS REGISTRATION FORM

STUDENT INFORMATION

First Name*

Answer required for "First Name"

Last Name*

Answer required for "Last Name"

Date of Birth*

Answer required for "Date of Birth"

Grade as of September 2026*

Answer required for "Grade as of September 2026"

8th Grade

9th Grade

10th Grade

11th Grade

12th Grade

Other:

Gender*

Answer required for "Gender"

Male

Female

Other:

Student Phone*

Number Required

Student Email*

Answer required for "Student Email"

Student School*

Answer required for "Student School"

Are there any learning needs, accommodations, or supports that would help us create the best experience for your teen?

Answer required for "Are there any learning needs, accommodations, or supports that would help us create the best experience for your teen?"

PARENTS INFORMATION

Parent 1 First Name*

Answer required for "Parent 1 First Name"

Parent 1 Last Name*

Answer required for "Parent 1 Last Name"

Parent 1 Phone*

Number Required

Parent 1 Email*

Answer required for "Parent 1 Email"

Parent 2 First Name

Answer required for "Parent 2 First Name"

Parent 2 Last Name

Answer required for "Parent 2 Last Name"

Parent 2 Phone

Number Required

Parent 2 Email

Answer required for "Parent 2 Email"

Address*

Answer required for "Address"

City*

Answer required for "City"

State*

Answer required for "State"

Zip Code*

Answer required for "Zip Code"

ADDITIONAL INFORMATION

Non-Parent Emergency Contact Name*

Answer required for "Non-Parent Emergency Contact Name"

Non-Parent Emergency Contact Relationship to Participant *

Answer required for "Non-Parent Emergency Contact Relationship to Participant "

Non-Parent Emergency Contact Phone Number*

Number Required

HEBERW PROGRAM TO CHOOSE

I Request Hebrew Credit (only available for below options 1, 2, and 3) *

Answer required for "I Request Hebrew Credit (only available for below options 1, 2, and 3) "

Yes

I am registering for:*

Answer required for "I am registering for:"

Day/s of Learning*

Answer required for "Day/s of Learning"

If "Other" Was Chosen Above, Please Explain

Answer required for "If \"Other\" Was Chosen Above, Please Explain"

FINALIZING THE REGISTRATION PROCESS

Payment can be made by credit card or by check*.
If you need financial aid or a special payment arrangement, please fill out the @akiva Programs Financial Aid Request form at https://www.akivacleveland.org/apps/form/akivaFAForm

Credit Card Payment Breakdown

Program Fee: $1085 ($1000 Tuition plus $85 Learning Materials)
Credit Card Processing Fee: $43.75
Total: $1128.75

Program Fee for a second child: $985 ($900 Tuition plus $85 Learning Materials)
Credit Card Processing Fee: $39.75
Total: $1024.75

Check Payment Option

To avoid the additional credit card fee, you may send a $ 1,085 (or $985) check payable to the Jewish Education Center of Cleveland. 2030 South Taylor Rd. Cleveland Heights, OH 44118.

I plan to use the following payment method:*

Answer required for "I plan to use the following payment method:"

Credit Card

Check

PARENT OR GUARDIAN SIGNATURE

Signature*

Signature Required

Please fix the highlighted areas below before submitting.

2026-27 HEBREW PROGRAMS REGISTRATION FORM

Credit Card Payment Breakdown

Check Payment Option