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We are currently accepting application forms for GRADES K-7 for the 2021-2022 school year. Please fill out ALL fields of this form. Fill out one form per child. If you have any questions or concerns you'd like to discuss with us, please contact us.

Student Profile - Child
 
First Name
Last Name
Hebrew Name
DOB
Current School
Grade Entering in 2021-2022
My Child's Reading
 
Parent Information
 
Mother's Name
Mother's Hebrew Name
Mother's Home Phone
Mother's Work Phone
Mother's Cell Phone
Address
City
State
Zip
Mother's Email Address
Father's Name
Father's Hebrew Name
Father's Home Phone
Father's Work Phone
Father's Cell Phone
Address
City
State
Zip
Father's Email Address
Family Information
 
My child is a Kohen Levite Israelite
Not Sure
Mother is

Jewish by birth
Jewish by Choice
Not Jewish
Please explain:
Have there been any conversions to Judaism in the family? Yes No
If yes, please explain:
Emergency Contact Information
 
Emergency Contact Name
Relationship to Child
Home Phone
Cell Phone
Work Phone

CONFIDENTIAL: Does your child have any medical, developmental or behavioral issues that we should know about? If yes, please describe them and indicate special precautions or care needed. 

Does your child take any medications on a regular basis?
Yes  No
Does your have any allergies towards food or medication?
 Yes   No
Additional Information you would like to provide: 

Payment Options:

  One payment in full: $700 per child
  Ten monthly payments of $70 per child starting in September.

 Payment Method: (Check or Credit Card)
I am mailing one check for payment in full 
I am mailing Ten postdated checks, dated as indicated above 
 
Credit cards are charged the beginning of the month.
Please charge my credit card for payment in full
Please charge my credit card monthly 

Credit Card Information:

 Cardholder's Name                                                         
 Card Number
 Expiration Date
 CVV Security Code 

 

Billing Address:

Street Address                                                            
City
State, Zip

 

TERMS OF AGREEMENT:

  • I have completed the above registration form and arranged the appropriate payment for my child to attend the Chabad Hebrew School. 
  • I give permission for my child to take class trips with the Chabad Hebrew School.
  • I take responsibility for any damage caused by my child at the Chabad Hebrew School facility.
  • I understand that this Hebrew School enrollment does not validate, endorse or involve and Jewish conversion for the student. 
  • In the event of an emergency, I agree that the Chabad Hebrew School has my permission to arrange for any necessary first aid or care by a licensed physician for my child while he/she is attending school. I further agree to pay all charges for that care and/or treatment.
  • I authorize Chabad Hebrew School to use and reproduce any photographs or audio and video recording of my child's participation for any and all purposes.
  • I acknowledge that Chabad Hebrew School serves children who can function successfully in a group setting. If, in the judgement of the school's Director, the child is not able to function in a group setting, the parent may be asked to withdraw the child.

 

As parent or legal guardian, I agree to the terms of agreement by checking this box.
Yes

 

Name 

 

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