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Chabad Hebrew School

Register Online
We are currently accepting application forms for the 2021-2022 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 Name*
Hebrew Name*
Birth Date*
MonthDayYear
School*
Grade Entering*
Hebrew Reading Proficiency*
NoneSomewhatWell
Previous Jewish Education*
YesNo
Where?
Is the natural mother and maternal grandmother of the child Jewish?*
YesNo
Have there been any conversions or adoptions in the family? If Yes, please explain.
Parent Information
Father's Name*
Phone Number*
Area CodePhone Number
Mother's Name*
Phone Number*
Area CodePhone Number

Address*

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

E-mail*
Emergency Information
Emergency Contact 1*
Phone Number*
Area CodePhone Number
Emergency Contact 2*
Phone Number*
Area CodePhone Number
Medical InformationCONFIDENTIAL: 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
Annual tuition is $550.00, with a registration fee of $25.00
Payment options*
I would like to pay a one-time installment of $575.00 (tuition + registration fee)I would like to pay in 5 installments of $110.00 and pay the $25.00 registration fee now.
Total
$0.00

Payment*

Credit Card

Credit Card Type
Credit Card Number	Security Code
Name on Card
Expiration Month	Expiration Year

Billing Address

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Country

Other
Questions/Comments
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*
Yes
Full Name*
First NameLast Name
Initials:*
We look forward to a wonderful year of learning and growth!
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