Name of Student:
Student's Declaration

Please reserve a space for me at YSMZ. I agree to be in attendance for the entire and complete academic year (beginning September 6, 2016), to attend all classes and activities, fulfill all academic requirements and adhere to all policies, rules and regulations.

Student's Signature (Please enter the student's name as a signature.)
Date signed: (Please enter the date the student signed the agreement.)
Parent's Declaration

I recognize that by registering my son for YSMZ, I am committing to abide by the schedule of payments listed on the financial information page. (If I choose to register my son for the Yeshiva University Joint Israel Program, I will send a copy of the confirmation letter by May 9, and confirmation of payments when available.) I also realize that the $3300 registration fee is not refundable under any circumstances, and I agree to the financial refund policy. I am enclosing the $3300 registration fee, and I will arrange for the balance of tuition (via FACTS for the July 7 and October 3 payments or Yeshiva University documents) by May 9, 2016.

Parent's Signature (Please enter the parent's name as a signature.)
Date signed: (Please enter the date the parent signed the agreement.)

As explained on the financial information page, the non-refundable registration deposit is $3300.

Credit Card Information
Card Holder Name:
Card Type:
Card Number:
Card Validation Number:
Expiration Date: /