Registration & Tuition Contract

Registration

At Bais Menachem we maintain an open enrollment policy. Openings for new participants are available on a first-come-first-served basis. Due to the nature of our program participants are accepted throughout the year, provided that they meet the criteria for acceptance at Bais Menachem.

Tuition & fees for Bais Menachem are as follows:

Tuition	$18,500
Initial Payment (Due by August 1)	$2,500
Security Deposit	$200
Book Fee	$75
Total Tuition	$18,775

1. Student Information
Full Name*
First Name Last Name
E-mail*
Phone Number*
2. Parent Information
Father's Name*
First Name Last Name
Mother's Name*
First Name Last Name
3. Emergency Contact
Full Name*
First Name Last Name
Phone Number*
Relationship*
4. Medical Information
Date of Birth*

Month Day Year
Insurance Card Front:*
Insurance Card Back:*
List allergies, medications, or chronic conditions we should be aware of.*
5. Tuition Agreement
Agreed Tuition Amount :*
Payment Method*
Notes:
Tuition Agreement Confirmation*

I acknowledge the tuition amount I have entered was agreed upon with Bais Menachem and Uri Perlman, and I agree to pay for the remainder of that month should my child leave.
6. Submit Payment
First Tuition Installment (Due by August 1)

$2,500
Security Deposit*

$200
Book Fee*

$75
Total

$0.00 USD

Payment*

Credit Card Zelle

Should be Empty:

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1. Student Information

2. Parent Information

3. Emergency Contact

4. Medical Information

5. Tuition Agreement

6. Submit Payment

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