Registration New Student RegistrationWe look forward to a wonderful year of learning and growth. Register your child for the new year. How many children are you registering today?* 1 2 3 Child 1 Name* First Last Hebrew Name DOB* MM slash DD slash YYYY Age*School Grade Entering*KindergartenFirstSecondThirdFourthFifthSixthSeventhSecond ChildChild 2 Name* First Last Hebrew Name* DOB* MM slash DD slash YYYY Age*School* Grade Entering*KindergartenFirstSecondThirdFourthFifthSixthSeventhThird ChildChild 3 Name* First Last Hebrew Name* DOB* MM slash DD slash YYYY Age*School* Grade Entering*KindergartenFirstSecondThirdFourthFifthSixthSeventhPrevious Jewish Education? Yes No Where? Please provide details:Parent/Guardian InformationParent/Guardian 1* First Last Cell Phone Number*Parent/Guardian 1 Email* Parent/Guardian 2 First Last Cell Phone NumberParent/Guardian 2 Email Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Persons to be contacted in case of an emergency when parents cannot be reached.Name 1* First Last Phone*Relationship to child* Name 2 First Last PhoneRelationship to child Other person(s) authorized to pick up child(ren)Name of Authorized Person First Last Cell Phone of Authorized PersonRelationship of Authorized Person General InformationCONFIDENTIAL: Does your child have any allergies or other medical condition, require medication, or any special abilities or disabilities we should be aware of?* Yes No Please describe them and indicate special precautions or care needed.As the parent(s) or legal guardian of the above child, I/we authorize any adult acting on behalf of SPARKS to hospitalize or secure treatment for my child, I further agree to pay all charges for that care and/or treatment.* I Accept It is understood that if time and circumstances reasonably permit, SPARKS personnel will try, but are not required, to communicate with me prior to such treatment. I hereby give permission for my child to participate in all school activities, join in class and school trips on and beyond school properties.* I Accept I hereby give permission for my child to be photographed while participating in SPARKS activities and that these pictures may be used for marketing purposes. I Accept Payment OptionsTuition Plans - 1 Child Plan A: One Full Tuition Payment - $1,350 Plan B: First Half Payment Upon Registration and Second Half Payment on January 1st - $675 Due Today Tuition Plans - 2 Children Plan A: One Full Tuition Payment - $2,700 Plan B: First Half Payment Upon Registration and Second Half Payment on January 1st - $1,350 Due Today Tuition Plans - 3 Children Plan A: One Full Tuition Payment - $4,050 Plan B: First Half Payment Upon Registration and Second Half Payment on January 1st - $2,025 Due Today Payment Method* Check Credit Card Please check one option.Billing Address For Payment Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Credit Card American ExpressDiscoverMasterCardVisaSupported Credit Cards: American Express, Discover, MasterCard, Visa Card Number Month010203040506070809101112 Year20222023202420252026202720282029203020312032203320342035203620372038203920402041 Expiration Date Security Code Cardholder Name Total $0.00 Name* Initials* We look forward to a wonderful year of learning and growth!