Yeshivas Kayitz Registration

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Yeshivas Kayitz Application

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Today's Date

Name*

First Last

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone*

Email*

Enter Email Confirm Email

Date of Birth*

S.I.N or S.S.N*

Father's Information

Father's Name*

First Last

Place of Work

Email*

Work Phone

Cell Phone*

Mother's Information

Mother's Name*

First Last

Place of Work

Email*

Cell Phone*

Work Phone

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Please upload a SMALL picture of your son

Accepted file types: jpeg, jpg, png, Max. file size: 8 MB.

Medical Information

Medical Insurance Information*

Please enter Emergency Contact Information*

Name, Telephone number, Relationship to you

Are there any Medical conditions we should know about? If yes, please provide details.

Acceptance of Yeshiva rules, please enter Talmid's name*

By entering talmid's name, you agree to follow all of the Yeshiva's rules.

Security Deposit Fee

Security Deposit Authorization:*

Security Deposit Authorzation

Credit Card

Card Details

Cardholder Name

Payment

Tuition Payment Options*

I would like to pay the tuition fee of $1,500 USD on this card plus a 3% transaction fee (total $1,545.00 USD)

I will be paying by check (We will contact you with details)

I will be Paying with Zelle, Paypal, Or Cashapp (We will contact you with details)

By submitting this form you agree to have your card charged $1450 + 3% processing fee for the tuition fee, for a Total of $1493.50 for the summer

Comments

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