Application

Student Information

Last Name* First Name* Hebrew Name*

Address* City* State* Zip*

Home Phone* E-mail Address*

Date of Birth* Gender*

Applying for grade* Current School*

Early Care:

After Care:

Mother's Information

Last Name* First Name* Hebrew Name *

Cell Number Work Number Email Address

Employer/Company Name Position

Address City State Zip

Father's Information

Last Name* First Name* Hebrew Name*

Cell Number Work Number Email Address

Employer/Company Name Position

Address City State Zip

Family Information

Parents:

Father remarried? Mother remarried?

If father remarried, enter name of stepparent

If mother remarried, enter name of stepparent

If parents are separated or divorced, who is the legal guardian?

To whom should correspondence be sent?

Student adopted? Student converted?

Conversion performed by Phone

Date of Conversion

Parent converted?

Conversion performed by Phone

Please list names, DOB, and current schools of all siblings.

Family Shul Affiliation Rabbi/Rav

Maternal Grandparent's Names Hebrew Name

Address City State Zip

Paternal Grandparent's Names Hebrew Name

Address City State Zip

Emergency Information

It is very important that the yeshiva office is informed of any change in your telephone number, email, or address.

List two relatives or neighbors who are authorized to pick-up and assume temporary care of your child if you cannot be reached:

Name Relationship Phone

Name Relationship Phone

In case of accident or serious illness, I request the school to call me. If the school is unable to reach me, I hereby authorize the school to call the physician listed below and to follow his/her instructions. If it is impossible to contact this physician, the school may make whatever arrangements seem necessary.

Name of Physician Phone

Address City State Zip

Signature of Parent/Guardian* Date*

Parental Consent Form for Daily Transportation

I, , do hereby authorize to pick up from Stein Yeshiva.

My child will be receiving bus transportation

Parent Initials

I will be carpooling with

Parent Request for Loan of Textbooks (Pre-1A—8th Grade)

Parent Information

Last Name First Name

Address City State Zip

Children's Information

Child 1

Child 2

Child 3

Child 4

Child 5

Dear Administrator of Funded Programs:

I request the loan of the textbooks listed on Stein Yehiva of Lincoln Park’s book forms for the school year. This request is in accord with the Educational Law section 701. I understand that textbooks are loaned to pupils attending public and nonpublic schools on an equitable basis. I ACCEPT THE FINANCIAL RESPONSIBILITY TO REPLACE ANY BOOK THAT IS LOST OR DAMAGED WHILE LOANED TO MY CHILD(REN).

Parent Iniitials Date

Release of Student Records

I, , give my permission to Stein Yeshiva of Lincoln Park to contact my child’s current or past schools to request the yearly report, most recent IEP, and other relevant records that are deemed necessary by Stein Yeshiva. All information is strictly confidential.

Permission is deemed granted by parent’s initials.

Please send the requested records of to:
Rabbi Joseph Cherns
Stein Yeshiva
287 Central Park Avenue
Yonkers, NY 10704

Parents, guardians, and anyone responsible for making tuition payments, are obligated for full payment of tuition and fees for the entire year regardless of whether the student is unable, or chooses not to complete the year. No deductions can be made if the student is absent from school, regardless of cause. The yeshiva has operational commitments which must be met and therefore cannot pro-rate any tuition should students terminate their attendance once the contract is initialed/signed. Should your child attend Stein Yeshiva without a signed contract, it is considered an implicit agreement to the terms of the contract. It is understood that Stein Yeshiva has the prerogative to terminate a student’s enrollment. Students are required to adhere to the school dress code and rules of decorum. A psychologist/social worker works with staff and students to assist in the educational process. Pictures taken at school may be used for publicity purposes.

I/We, , agree to the above terms and to pay Stein Yeshiva the above tuition amount for the children listed. It is agreed that in the unfortunate event of any dispute, both parties’ first recourse will be the Bais Din of Rabbi Ben-Zion Wosner. Any and all courts having jurisdiction that includes Westchester will be agreed upon the signatories as the proper form for civil litigation.

Please enter the contact information below for the person responsible for tuition payment:

Name* Phone*

Address* City* State* Zip*

Please initial that you agree to all terms.

Please send a confirmation email that this application has been received to the following email address*

Note: To make your tuition payment, please go to PayPal to submit your $100 registration and $700 deposit (secure link) towards tuition to complete the application process or submit a check with your application. These fees are not returnable, unless you are not accepted to the yeshiva or do not agree to the scholarship arrangement from the tuition committee. ($800 will be credited to your tuition account.)