Registration

Full Name*

Full Name

First Name Last Name

Hebrew Name*

Date of Birth*

Month Day Year

Current School*

Grade Entering 2023-2024*

Enrolling For

Hebrew School grades 1-6NEW Cteen Junior Program

My Child's Hebrew Reading Skill*

Mother's Name

First Name Last Name

Mother's Hebrew Name

Mother's Phone Number

Area Code Phone Number

Mother's E-mail

Father's Name

First Name Last Name

Father's Hebrew Name

Father's Phone Number

Area Code Phone Number

Father's E-mail

Address

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

My Child Is A

KohenLeviteIsraeliteNot Sure

Mother Is

Jewish by birthJewish by ChoiceNot Jewish

Please provide more details:

Have there been any adoptions or conversions to Judaism in the family including grandparents?

YesNo

Please provide more details:

Emergency Contact Name

First Name Last Name

Relationship to Child

Phone Number

Area Code Phone Number

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?

YesNo

Does your have any allergies towards food or medication?

YesNo

Additional Information you would like to provide:

Registration:

$30

Payment Options:*

One payment in full: $750 per childTen monthly payments of $75 per child starting in September.

Total

$0.00

Payment

Credit Card Check

Postal / Zip Code

Country

As parent or legal guardian, I agree to the 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 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 the boxes

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 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.

Signature*

Date*

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

Student Profile - Child

Parent Information

Family Information

Emergency Contact Information

Payment

Terms of Agreement