We are currently accepting application forms for the 2020-2021 school year.

Enrollment Form for Chabad Hebrew School

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
Paternal Grandfather
Paternal Grandmother
Maternal Grandfather
Maternal Grandmother

Were there any adoptions in the family? Yes No

 please elaborate 


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

  

Mother's Email   
Father Jewish By Birth   Conversion  Other
Mother Jewish By  Birth   Conversion   Other
    
Emergency Information
Emergency Contact 1
Cell
Relationship
Emergency Contact 2
Cell
Relationship

 

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 $750 per child. This includes book fees.
Payment Amount
Card Type
Card Number
Expiration Date
CVV Code

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: