Register  - For New Students ages 3 through 8 



 

We are currently accepting application forms for the 2013-2014 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.

Enrollment Form for Chabad Hebrew School ~ 2013-2014

Student Profile
First Name
Last Name
Hebrew Name
Age
DOB            
School
Grade Entering
Hebrew Reading Proficiency None    Somewhat    Well
Previous Jewish Education Yes            No
Where?


Family Information
My child is a
Are the natural father and mother of the child Jewish? Yes No
If no, please explain.
Have there been any conversions or adoptions in the family? Yes No
If yes, please explain.
Are you interested in carpooling?  Yes No
If yes, can we give your number to other parents? Yes No

Parent Information
I have already submitted this information
(previous child's registration form)
Father's Name
Mobile
Mother's Name
Mobile
Home Phone
Address
City
Zip
Email*
* Email address allows us to communicate in the most efficient and economical manner. We do not use your address for other purposes.

Emergency Information
Emergency Contact 1
Phone
Relationship
Emergency Contact 2
Phone
Relationship

Medical Information

CONFIDENTIAL: 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 Details
Registration must include a $50.00 non-refundable deposit.
Included is my $50 registration fee
I agree to pay $180.00 Tuition Fee and $50 Book and Material Fee by September 1, 2013)
Included is $230.00 (Registration Fee plus Tuition)
Included is $280.00 (Registration Fee plus Tuition plus Book & Material Fee) 
 
Payment Amount  
Card Type  
Card Number  
Expiration Date   
Cvv Code  

Please note: Our Sunday School First Taste program is subject to our enrolling a minimum number of students for each class.

Terms of Agreement

In the event of an emergency, Chabad Hebrew School has my permission to arrange for any necessary first-aid or care by a licensed physician/first-aid worker. Chabad Hebrew School has my permission to use my child's photo in its publicity materials. I have completed the Enrollment Form.

I Accept   

Name:     Initials:


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