Hebrew School Registration

Student Information
No. of Students registering*

1 child2 children3 children
Child 1
Registration Type*

New studentReturning student
Name of child *
First Name Last Name
Hebrew Name* If unknown / none, write 'unknown' or 'none'
Date of Birth*

Month Day Year
School*
Grade entering*
Hebrew Reading Proficiency*

NoneSomewhatWell
Previous Jewish Education*

YesNo
Where*
Please list any special needs that may require special awareness from our staff Special needs including physical, developmental, learning, emotional or behavioral
Child 2
If you wish to only register 1 child, scroll to top and change "No. of Students registering"
Registration Type*

New studentReturning student
Name (child 2)*
First Name Last Name
Hebrew Name (child 2)* If unknown / none, write 'unknown' or 'none'
Date of Birth (child 2)*

Month Day Year
School (child 2)*
Grade entering (child 2)*
Hebrew Reading Proficiency (child 2)*

NoneSomewhatWell
Previous Jewish Education (child 2)*

YesNo
Where?*
Please list any special needs that may require special awareness from our staff Special needs including physical, developmental, learning, emotional or behavioral
Child 3
If you wish to only register 1 or 2 children, scroll to top and change "No. of Students registering"
Registration Type*

New studentReturning student
Name (child 3)*
First Name Last Name
Hebrew Name (child 3)* If unknown / none, write 'unknown' or 'none'
Date of Birth (child 3)*

Month Day Year
School (child 3)*
Grade entering (child 3)*
Hebrew Reading Proficiency (child 3)*

NoneSomewhatWell
Previous Jewish Education (child 3)*

YesNo
Where*
Please list any special needs that may require special awareness from our staff Special needs including physical, developmental, learning, emotional or behavioral

Home address*

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Does your child/ren have allergies?* Food or medication

YesNo
Please describe allergies* Specify which child/ren
Does your child/ren take medication regularly?*

YesNo
Please outline medication* Specify which child/ren
Parents Information
Father's Name*
First Name Last Name
Father's Cell
Father's E-mail
Mother's Name*
First Name Last Name
Mother's Cell*
Mother's E-mail*
Mother's Hebrew Name
Mother born Jewish?*

YesNo
If there's conversions or adoptions in the family, please provide details.
Best way to send Hebrew School updates:*

Cell PhoneEmailHandout
Volunteer

I am willing to assist in school activities, please contact me
Emergency Information
Emergency Contact *
Phone Number*
Payment
Due now:
$150 per child ($200 per child for late registration)

$50 Registration fee ($100 with late registration),
$50 book/craft fee
$50 Security Guard fee
Tuition Payment plan:* Tuition for the year is $950 per child. Tuition PAID IN FULL before Hebrew School begins will receive a 5% discount.

Plan A - Pay in full before HS startsPlan B - 50% before HS starts and 50% Jan. 1stPlan C - Ten month payment plan - $95/student/month beginning Sep. 1st
Tuition agreement*

I have reviewed the tuition rates listed above and agree to pay the amount for my child/ren to attend Chabad Hebrew School.
$150 due now

$150 - 1 Child
$300 due now

$300 - 2 Children
$450 due now

$450 - 3 Children
$200 due now

$200 - 1 Child
$400 due now

$400 - 2 Children
$600 due now

$600 - 3 Children
Date

Month Day Year
at Hour Minutes

Payment

Credit Card

We accept Visa, MasterCard, American Express, Discover
Credit Card Number	Security Code
Name on Card
Expiration Month	Expiration Year

Billing Address

Street Address

City

State / Province

Postal / Zip Code

Country

Your email address* We'll send registration confirmation to this email
Terms of Enrollment*

As the parent(s) or legal guardian of the above child(ren), 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.
Promo Code
$50 Promo
$100 Promo
$150 Promo
Your card will be charged:

$2100.00
We look forward to a wonderful year of learning and growth!
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Educate Your Child... Educate a Generation

Student Information

Child 1

Child 2

Child 3

Parents Information

Emergency Information

Payment