Registration

 

We are currently accepting application forms for GRADES K-7 for the 2018-2019 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	Month   Jan.   Feb.   Mar.   Apr.   May   Jun.   Jul.   Aug.   Sept.   Oct.   Nov.   Dec.    Date   1   2   3   4   5   6   7   8   9   10   11   12   13   14   15   16   17   18   19   20   21   22   23   24   25   26   27   28   29   30   31    Year   2003   2004   2005   2006   2007   2007   2008   2009   2010   2011   2012   2013   2014
School
Grade Entering in 2018-2019	Grade Entering Kindergarten First Second Third Fourth Fifth Sixth Seventh Eighth
My Child's Reading	Hebrew Reading Skill Does Rot Read Hebrew Recognizes letters of the Alef-Bet Can Read Hebrew Slowly Can Read Hebrew Very Well

Parent Information
Mother's 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 Home Phone
Father's Work Phone
Father's Cell Phone
Address
City
State
Zip
Father's Email Address

Family Information
My child/ren is/are	Kohen Levite Israelite Not Sure
Are the biological mother and the maternal grandmother of the child(ren) Jewish?	Yes No
If no, 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
Home Phone
Cell Phone
Work Phone

CONFIDENTIAL: Does your child have any allergies or other medical conditions? If yes, please describe them and indicate special precautions or care needed. 

Additional Information you would like to provide: 

PAYMENT:

Payment Options:

 One payment in full: $700

 Ten monthly payments of $70.00 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:

 

Card Number 

Expiration Date: month year 

CVV SECURITY CODE 

 

Billing Address (include zip)

 

Cardholder’s Name 

 

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 any
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 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.

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!