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Hebrew School Registration

Hebrew School Registration

Chabad Hebrew School Educate your child... educate a generation!

We are currently accepting application forms for the 2017- 2018 school year.

Please fill out ALL fields of this form. If you have any questions or concerns you'd like to discuss with us, please contact us.  Please note that one registration form per child is needed.

We look forward to a wonderful year of learning and growth.

Student Profile
 
Student's First Name
Last
Hebrew Name
DOB
School
Grade Entering
Hebrew Reading Proficiency None Somewhat Well
Previous Jewish Education Yes No
Where?
Is the natural mother and maternal grandmother of the child Jewish? Yes No
Have there been any conversions or adoptions in the family? If Yes, please explain.

 

Parent Information
 
Father's Name
Phone
Mother's Name
Phone
Home Address
City
State
Zip
Email Address

 

Emergency Information
 
Emergency Contact 1
Phone
Emergency Contact 2
Phone

CONFIDENTIAL: Does your child have any allergies or other medical condition we should be aware of? If yes, please describe them and indicate special precautions or care needed.

Payment Information - $600 annual tuition
 

Payment by check

Credit Card payment
Credit Card Number
Billing Address
CVV
Expiration Date


As the parent(s) or legal guardian of the above child, I/we authorize any adult acting on behalf of Chabad Hebrew School to hospitalize or secure treatment for my child, I further agree to pay all charges for that care and/or treatment. It is understood that if time and circumstances reasonably permit, Chabad Hebrew School 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 and allow my child to be photographed while participating in Chabad Hebrew School activities and that these pictures may be used for marketing purposes.

I Accept

Name: Initials:

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