Registration

Student Profile
Full Name*

First Name Last Name
Hebrew Name*
Gender

MaleFemale
Birth Date*

Month Day Year
Time of day born Please specify AM or PM

Hour Minutes
School*
Grade Entering* Grades K -7
Hebrew Reading Proficiency*

WellSomewhatNone
Previous Jewish Education*

YesNo
Where?
Jewish Family Background
Father*
Mother*
Maternal Grandmother*
Were there any adoptions or conversions in the family?*

yesno
If yes, please elaborate
Parent Information
Father's Name*

First Name Last Name
Father's Cell*

Area Code Phone Number
Father's Email*
Mother's Name*

First Name Last Name
Mother's Cell*

Area Code Phone Number
Mother's Email*
Home Phone

Area Code Phone Number

Address*

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

Emergency Contact Information
Name*

First Name Last Name
Phone Number*

Area Code Phone Number
Relationship*
Child's physician or medical facility
Phone Number

Area Code Phone Number
Health Insurance
Group #
ID #
Does your child have any allergies or other medical condition we should be aware of?*

yesno
If yes, please describe and indicate precautions or care needed.
Does your child take behavioral medication during regular school hours?*

YesNo
Are there any learning styles which work best for your child? Please detail them here.
Terms of Agreement
As the parent(s) or legal guardian of the above child, I/we authorize any adult acting on behalf of Chabad Hebrew School to hospitalize or secure treatment for my child, I further agree to pay all charges for that care and/or treatment. It is understood that if time and circumstances reasonably permit, Chabad Hebrew School personnel will try, but are not required, to communicate with me prior to such treatment.
*

I Agree
I hereby give permission for my child to participate in all school activities, join in class and school trip on and beyond school properties.
*

I Agree
I allow my child to be photographed during Hebrew School. I understand that these photos may be used on social media. Name of child will not be included in publicity without separate additional parental permission for the specific media.
*

I Agree
Initial Here:
Payment Information
The tuition for the Chabad Hebrew School is $790.00 per year per child (this includes registration & book fee).

Discounts:

Siblings: $50 off regular tuition for each additional child.

Referral: There is an additional $50 discount off your child's tuition for each new family successfully introduced to Natick Hebrew School.
Tuition* Select your payment option. We will contact you for Payment Plans

$790Discount: Signed up a SiblingDiscount: Referred a Friend
Payment

$0.00 USD

Payment

Credit Card eCheck Check

Postal / Zip Code

Country

How did you hear about Chabad Hebrew School?
I would like to receive news and updates by email
For questions or comments, feel free to contact our Hebrew School Director, Chanie Fogelman at [email protected]
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Educate Your Child... Educate a Generation