Religious School/ MC Teens/ Confirmation Registration Form 2016-2017

Please use the online form below to register for religious school.

*Tuition:

PreK is $130
K is $515
Grades 1-2 $515
Grade 3 $575 (includes $60 for siddur)
Grades 4-7 $625

There is a tuition cap of $1250 per family for grades 1-7 only.
MC Teens and Confirmation registration are NOT included in this cap.
MC Teens Grade 8,9,11,12 $300
Confirmation grade 10 $325

All registrations must be submitted online and paid in full prior to the first day of religious school.
Full tuition payments should be made online or sent to: 
W&K
111 Roberts Street, Suite G-1
East Hartford, CT 06108-3666

Make checks payable to FVJC-ES, with a note in the memo section "RS Tuition.

Thank you and we look forward to seeing you at Religious School!

  1. Student Information

  2. Name(*)
    Please type your full name.
    First, Middle, Last
  3. Hebrew Name (Use English Transliteration only)
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  4. Are you New to FVJC-ES?(*)
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  5. Date of Birth
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  6. Secular School(*)
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  7. Grade in Secular School (*)
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  8. Grade in Religious School/MCTeens/Confirmation(*)
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  9. Allergies or medical conditions we need to be aware of:
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  10. Does this child have an IEP or 504 in secular school?(*)
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  11. If you answered yes to the above question, please provide specifics:
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  12. Please describe your child's learning style including any special needs:
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  1. Skip and click next at the bottom if you do not have any more students to enroll
  2. 2nd Student Information (if applicable)

  3. Name
    Please type your full name.
    First, Middle, Last
  4. Hebrew Name
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  5. Date of Birth
    / / Invalid Input
  6. Secular School
    Invalid Input
  7. Are you New to FVJC-ES?
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  8. Grade in Secular School
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  9. Grade in Religious School/MCTeens/Confirmation
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  10. Allergies or medical conditions we need to be aware of:
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  11. Does this child have an IEP or 504 in secular school?
    Invalid Input
  12. If you answered yes to the above question, please provide specifics:
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  13. Please describe your child's learning style including any special needs:
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  14. 3rd Student Information (if applicable)

  15. Name
    Please type your full name.
    First, Middle, Last
  16. Hebrew Name
    Invalid Input
  17. Date of Birth
    / / Invalid Input
  18. Secular School
    Invalid Input
  19. Are you New to FVJC-ES?
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  20. Grade in Secular School
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  21. Grade in Religious School/MCTeens/Confirmation
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  22. Allergies or medical conditions we need to be aware of:
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  23. Does this child have an IEP or 504 in secular school?
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  24. If you answered yes to the above question, please provide specifics:
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  25. Please describe your child's learning style including any special needs:
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  1. Other children in the home

  2. Names/ Ages
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  3. Parent Information

  4. Parent 1
  5. First Name (parent 1)(*)
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  6. Last Name (parent 1)(*)
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  7. Home Address(*)
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  8. City(*)
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  9. Zip Code(*)
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  10. Email Address(*)
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  11. Home Phone (xxx-xxx-xxxx)(*)
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  12. Cell Phone (xxx-xxx-xxxx)(*)
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  13. Custodial arrangements of which we should be aware:
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  14. Will you receive religious school emails? (at least one parent must indicate yes)(*)
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  15. Do you want to be included in our Religious School Directory:(*)
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  16. Parent 2 (if applicable)
  17. First Name (parent 2)
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  18. Last Name (parent 2)
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  19. Cell Phone
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  20. Email Address
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  21. Will you receive religious school emails? (at least one parent must indicate yes)
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  22. Parent 2, Complete only if different than information provided above
  23. Home Address
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  24. City
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  25. State
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  26. Zip Code
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  27. Home Phone (xxx-xxx-xxxx)
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  1. Emergency Information

  2. Name (*)
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  3. Phone (xxx-xxx-xxxx)(*)
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  4. Relationship(*)
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  5. Medical Authorization

  6. I hereby authorize FVJC to obtain necessary emergency care for my child in the event of sudden illness, accident, or other injury that may occur while said minor is engaged in an activity supervised by FVJC representatives or employees, when neither the parent nor guardian can be contacted. I hereby give consent for treatment as shall be necessary under the circumstances by any physician licensed under the laws of the State of Connecticut.
  7. Full Name (signature)(*)
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  8. Today's Date(*)

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  9. Photo Authorization(*)
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  10. Parent Participation

  11. Parent participation is vital to our programming. We invite you to consider all of the options below. Getting involved is fun... And the Religious School needs your help.
  12. Please check the box corresponding to your interest:
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  13. Special skill you would like to share:
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  14. Fees

  15. *Please note: Tuition must be paid or arrangements made prior to the first day of school.
    Pre K $130 K $515 Grades 1-2 $515
    Grade 3 $575 (Includes siddur)
    Grades 4-7 $625
    MC Teens Grade 8,9,11,12 $300
    Confirmation grade 10 $325
    There is a tuition cap of $1250 per family for grades K-7. MC Teens registration and Confirmation are NOT included in this cap.


    Full tuition payments should be made online or sent to W&K 111 Roberts Street, Suite G-1 East Hartford, CT 06108-3666 * If you are joining mid-year, please contact the office regarding pro-rated tuition fees.
  16. Would you like to pay in full online with your credit or debit card?(*)
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  17. Send your check (payable to FVJC): White & Katzman 111 Roberts Street, Suite G-1 East Hartford, CT 06108-3666
  18. Select your payment amounts(*)












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  19. Total
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  20. Please enter the letters & numbers(*)
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