Yeshivas Kayitz Program sun The Hershey & Raisy Friedman Campus

Beis Medrash Registration Application

Talmid’s Information

A recent picture of the talmid is required to be submitted prior to acceptance.

Profile
Please upload a photo *
  • First Name
  • Last Name
  • Legal Name
  • Hebrew Name Ben Mother
  • Sweatshirt Size
  • Sweatpants Size
  • Yarmulka Size
  • Date Of Birth
  • Hebrew Birthday *

Family Info

  • Marital Status
  • Home Address
  • City
  • State
  • Zip
  • Country
  • Parents Summer Location
  • Address is current

Father’s Information

  • Fathers Name
  • Fathers Occupation
  • Fathers Cell
  • Fathers Work Phone
  • Fathers Email

Mother’s Information

  • Mothers Name
  • Mothers Occupation
  • Mothers Cell
  • Mothers Work Phone
  • Mothers Email

Yeshiva Information

  • Yeshiva attended this year
  • Shiur
  • Maggid Shiur's Name
  • Maggid Shiur's Phone
  • Mashpia's Name
  • Mashpia's Phone
  • Camp attended last year
  • Previous camp phone number
  • Yeshiva attending next year

Medical

Please answer the below questions.

  • Does your son have frequent headaches or migraines?

  • If yes, please explain

  • Does your son have any allergies?

  • If yes, please explain

  • Does your son have any eating limitations?

  • If yes, please explain

  • Is your son taking any sort of medication?

  • If yes, please explain

  • Has your son been diagnosed with any condition?

  • If yes, please explain

  • Has your son ever needed psychological or psychiatric attention?

  • If yes, please explain

Payment Method

There is a non-refundable $500.00 application fee which upon acceptance will be applied to tuition.

  • Please make checks payable to Yeshivas Kayitz
    You can mail your check to:
    Yeshivas Kayitz Program
    667 Eastern Parkway
    Brooklyn, NY 11213
    If you would like to drop it off please contact us

My Cards

  • You have no cards connected to your account, please add a new card
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Agreements

I understand that if my son is sent home from Yeshivas Kayitz or leaves early no tuition will be refunded.

 
 

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  • Full Name
  • Phone Number
  • Email Address
  • Password
  • Confirm Password
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Add Cards

  • Card Holder
  • Card Number
  • MM / YY
  • CVC
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Verify Bank

  • •••• 1234 Bank statement
    Transaction Amount Date
    SMxxxx
    -YKPROGRAM     		$0.01 Jul 15
    Groceries -$80.00 Jul 14

    To verify this account, enter the 6-digit code starting with “SM” from that deposit.
    SMXXXX-YKPROGRAM

  • Descriptor

Paying by Check?

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Once your check is received, your application will be submited

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