We are currently accepting application forms for the 2019-2020 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

Student Profile
First Name
Last Name
Hebrew Name
Grade Entering
Hebrew Reading Proficiency None Somewhat Well
Previous Jewish Education Yes No

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
Mother's Name
Home Phone
* 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
Emergency Contact 2

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
Tuition per child is $450 per child plus $45 books and supply fee = $495
Payment Amount
Card Type
Card Number
Expiration Date
Cvv Code
Referral Discount:  If you refer a family to our Hebrew School, you may receive a $25 discount on your tuition (or a rebate if you've paid already).  This applies only once the family has registered.  

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!