Registration

How many students are you signing up?
123
Student Profile
Full Name*
First NameLast Name
Hebrew Name*
Gender
MaleFemale
Birth Date*
MonthDayYear
Time of day bornPlease specify AM or PM
HourMinutes
School*
Grade Entering*Grades K -7
Hebrew Reading Proficiency*
WellSomewhatNone
Previous Jewish Education*
YesNo
Where?
Student 2 Profile
Full Name*
First NameLast Name
Hebrew Name*
First NameLast Name
Gender
MaleFemale
Birth Date*
MonthDayYear
Time of day bornPlease specify AM or PM
HourMinutes
School*
Grade Entering*Grades K -7
Grade Entering*Grades K -7
Hebrew Reading Proficiency*
WellSomewhatNone
Previous Jewish Education*
YesNo
Where?
Does your child take behavioral medication during regular school hours?*
YesNo
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.
Are there any learning styles which work best for your child? Please detail them here.
Student 2 Profile
Full Name*
First NameLast Name
Hebrew Name*
First NameLast Name
Gender
MaleFemale
Birth Date*
MonthDayYear
Time of day bornPlease specify AM or PM
HourMinutes
School*
Grade Entering*Grades K -7
Hebrew Reading Proficiency*
WellSomewhatNone
Previous Jewish Education*
YesNo
Where?
Does your child take behavioral medication during regular school hours?*
YesNo
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.
Are there any learning styles which work best for your child? Please detail them here.
Student 3 Profile
Full Name*
First NameLast Name
Hebrew Name*
First NameLast Name
Gender
MaleFemale
Birth Date*
MonthDayYear
Time of day bornPlease specify AM or PM
HourMinutes
School*
Grade Entering*Grades K -7
Hebrew Reading Proficiency*
WellSomewhatNone
Previous Jewish Education*
YesNo
Where?
Does your child take behavioral medication during regular school hours?*
YesNo
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.
Are there any learning styles which work best for your child? Please detail them here.
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 NameLast Name
Father's Cell*
Area CodePhone Number
Father's Email*
Mother's Name*
First NameLast Name
Mother's Cell*
Area CodePhone Number
Mother's Email*
Home Phone
Area CodePhone Number

Address*

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

Emergency Contact Information
Name*
First NameLast Name
Phone Number*
Area CodePhone Number
Relationship*
Child's physician or medical facility
Phone Number
Area CodePhone Number
Health Insurance
Group #
ID #
Terms of Agreement
As the parent(s) or legal guardian of the above child(ren), I/we authorize any adult acting on behalf of Chabad Hebrew School to hospitalize or secure treatment for my child(ren), 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.
Medical care permissions*
I Agree
I hereby give permission for my child(ren) to participate in all school activities, join in class and school trip on and beyond school properties.
Permission for activities*
I Agree
I allow my child to be photographed during Hebrew School. I understand that these photos may be used in publications and/or on social media.
Permission for photos*
I Agree
Initial Here:
Payment Information
The 2022-2023 tuition for the GEO Jewish After School per child per month is:

2 days - $295
3 days - $435
4 days - $525
Discounts:
Siblings: 10% off regular tuition for each additional child.
Referral: There is an additional $50 discount off your child's tuition (for the year which will be deducted from your tuition over 2 months) for each new family successfully introduced to GEO Jewish After School.
Please use this comment box if there's anything to explain about tuition otherwise leave blank
Days of WeekPlease check all that apply
MondayTuesdayWednesdayThursday
Tuition options*Monthly tuition for 2022-2023. Includes 10% discount here per addtl. sibling. This payment is the deposit towards the last month. After this registration is submitted you are entered into the billing system for future payments.
1 Child, 2 days1 Child, 3 days1 Child, 4 days2 Siblings, 2 days2 Siblings, 3 days2 Siblings, 4 days3 Siblings, 2 days3 Siblings, 3 days3 Siblings, 4 days
TuitionPlease choose "Other" if it's anything different than tuition for 1-3 siblings and fill in the correct amount
1 Child (250)2 Children (Sibling Discount -10% - 475)3 Children (Sibling Discount - 10% addtl. child - 700)1 Child, 2 days ($295)1 Child, 3 days ($435)1 Child, 4 days ($525)2 Siblings, 2 days (Sibling Discount -10% - $590 - $29.50) ($560.50)2 Siblings, 3 days (Sibling Discount -10% - $870 - $43.50) ($826.50)2 Siblings, 4 days (Sibling Discount -10% - $1050 - $52.50) ($997.50)3 Siblings, 2 days (Sibling Discount - 10% addtl. child $885 - $59) ($826)3 Siblings, 3 days (Sibling Discount - 10% addtl. child $1305 - $87) ($1218)3 Siblings, 4 days (Sibling Discount - 10% addtl. child $1575 - $105) ($1470)
Tuition amount
$0.00 USD

Payment

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Postal / Zip Code

Country

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For questions or comments, feel free to contact our Hebrew School Director, Chanie Fogelman at [email protected]
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