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Register



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 (Optional)
DOB             
School
Grade Entering
Hebrew Reading Proficiency None    Somewhat    Well
Previous Jewish Education Yes            No
Where?

 

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, food restrictions or other medical condition we should be aware of?  If yes, please describe them and indicate special precautions or care needed. Is there anything else that you think would be helpful for us to know about your child?

 

Payment Information

Regular price - $180/semester. Sibling discounts available

 
Contact Details
Title 
City  
  
First Name 
State / Zip 
  / 
Last Name 
Phone 
Address 
Email 
 This is my home address 
 This is my business address
Credit Card Details
Total To be Charged TODAY 

 
Card Number 
Expiration Date: (MM/YYYY)   
Card Type 
CVV Security Code  


 

 

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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