Register Online

We are currently accepting application forms for the 2016-2017 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
Name
Last
Hebrew Name
DOB              
School
Grade Entering  
Hebrew Reading Proficiency None    Somewhat    Well
Previous Jewish Education Yes            No
Where?
Is the biological mother of the child Jewish?
Were there any conversions or adoptions in your family?
If there has been a conversion, please indicate which Bet Din officiated
If there has been a conversion please send in a copy of Certificate.

 

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

 

Emergency Information
Emergency Contact 1
Phone
Emergency Contact 2
Phone
Doctor
Phone

 

Payment Information
Tuition for the year per child: $600 (discount ends July 10)
Method of payment:  
Full payment   1/2 Now, 1/2 by August 25Special arrangement
First Name
Last Name
Billing Address
City
State
Zip
Credit Card Number
CVV
Exp Date
Amount to Charge

 

 

 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.   

 

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:

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