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Register

Register

We are currently accepting application forms for the 2017-2018 school year. Please fill out ALL necessary fields of this form. If you have any questions or concerns you'd like to discuss with us, please contact us.

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

Student Profile

Student 1 Student 2 Student 3
Student's Full Name
Student's Full Name
Student's Full Name
Hebrew Name
Hebrew Name
Hebrew Name
Date of Birth
Date of Birth
Date of Birth
Gender
Gender
Gender
School Attending PS#
School Attending PS #
School Attending PS #
Entering Grade
Entering Grade
Entering Grade
Hebrew Reading Proficiency
None Somewhat Well
Hebrew Reading Proficiency
None Somewhat Well
Hebrew Reading Proficiency
None Somewhat Well
Previous Jewish Education
Yes No
Previous Jewish Education
Yes No
Previous Jewish Education
Yes No
Where?
Where?
Where?
Is mother of child attending Hebrew School Jewish? Yes No

Were there any conversions or adoptions in your family?

Yes No
If Yes, please describe:

 

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

 

Emergency Information
 
Emergency Contact 1
Phone
Emergency Contact 2
Phone

 


 

Doctor
Address
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
Sunday School, 400 annual tuition, including Book Fee

Amount

400 (1 child) $800 (2 children)

 

  Pay by Credit Card
Credit Card Number
Billing Address
CVV
Expiration Date

 

Please select all that apply:

 Sibling Discount: First child is full price, each additional child receives 10% off.
 Refer a friend: 10% discount if you refer a friend who signs up.
     Friend's name  


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!

 

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