How many students are you signing up?123Student ProfileFull Name*First NameLast NameHebrew Name*GenderMaleFemaleBirth Date*1 - January2 - February3 - March4 - April5 - May6 - June7 - July8 - August9 - September10 - October11 - November12 - DecemberMonth12345678910111213141516171819202122232425262728293031Day2022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920YearTime of day bornPlease specify AM or PM123456789101112Hour001020304050MinutesAMPM School*Grade Entering*Grades K -7Hebrew Reading Proficiency*WellSomewhatNonePrevious Jewish Education*YesNoWhere?Student 2 ProfileFull Name*First NameLast NameHebrew Name*First NameLast NameGenderMaleFemaleBirth Date*1 - January2 - February3 - March4 - April5 - May6 - June7 - July8 - August9 - September10 - October11 - November12 - DecemberMonth12345678910111213141516171819202122232425262728293031Day2022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920YearTime of day bornPlease specify AM or PM123456789101112Hour001020304050MinutesAMPM School*Grade Entering*Grades K -7Grade Entering*Grades K -7Hebrew Reading Proficiency*WellSomewhatNonePrevious Jewish Education*YesNoWhere?Student 2 ProfileFull Name*First NameLast NameHebrew Name*First NameLast NameGenderMaleFemaleBirth Date*1 - January2 - February3 - March4 - April5 - May6 - June7 - July8 - August9 - September10 - October11 - November12 - DecemberMonth12345678910111213141516171819202122232425262728293031Day2022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920YearTime of day bornPlease specify AM or PM123456789101112Hour001020304050MinutesAMPM School*Grade Entering*Grades K -7Hebrew Reading Proficiency*WellSomewhatNonePrevious Jewish Education*YesNoWhere?Student 3 ProfileFull Name*First NameLast NameHebrew Name*First NameLast NameGenderMaleFemaleBirth Date*1 - January2 - February3 - March4 - April5 - May6 - June7 - July8 - August9 - September10 - October11 - November12 - DecemberMonth12345678910111213141516171819202122232425262728293031Day2022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920YearTime of day bornPlease specify AM or PM123456789101112Hour001020304050MinutesAMPM School*Grade Entering*Grades K -7Hebrew Reading Proficiency*WellSomewhatNonePrevious Jewish Education*YesNoWhere?Jewish Family BackgroundFather*Jewish By BirthJewish By ConversionNot JewishMother*Jewish By BirthJewish By ConversionNot JewishMaternal Grandmother*Jewish By BirthJewish By ConversionNot JewishWere there any adoptions or conversions in the family?*yesnoIf yes, please elaborateParent InformationFather's Name*First NameLast NameFather's Cell*Area CodePhone NumberFather's Email*Mother's Name*First NameLast NameMother's Cell*Area CodePhone NumberMother's Email*Home PhoneArea CodePhone NumberAddress*Street AddressStreet Address Line 2CityState / ProvincePostal / Zip CodePlease SelectUnited StatesAfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanThe BahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChilePeople's Republic of ChinaRepublic of ChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongoCook IslandsCosta RicaCote d'IvoireCroatiaCubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonThe GambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorthern MarianaNorwayOmanPakistanPalauPanamaPapua New GuineaParaguayPeruPhilippinesPitcairn IslandsPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint BarthelemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSomalilandSouth AfricaSouth OssetiaSpainSri LankaSudanSurinameSvalbardSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTristan da CunhaTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamBritish Virgin IslandsUS Virgin IslandsWallis and FutunaWestern SaharaYemenZambiaZimbabweOtherCountryEmergency Contact InformationName*First NameLast NamePhone Number*Area CodePhone NumberRelationship*Child's physician or medical facilityPhone NumberArea CodePhone NumberHealth InsuranceGroup #ID #Does your child have any allergies or other medical condition we should be aware of?*yesnoIf yes, please describe and indicate precautions or care needed.Does your child take behavioral medication during regular school hours?*YesNoAre there any learning styles which work best for your child? Please detail them here.Terms of AgreementAs 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 AgreeI 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 AgreeI 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 AgreeInitial Here:Payment InformationThe 2022-2023 tuition for the GEO Jewish After School per child per month is: 2 days - $295 3 days - $435 4 days - $525Discounts: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 blankDays of WeekPlease check all that applyMondayTuesdayWednesdayThursdayTuition 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 daysTuitionPlease choose "Other" if it's anything different than tuition for 1-3 siblings and fill in the correct amount1 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 USDPaymentCredit Card eCheck Check Credit CardVisaMasterCardAmerican ExpressDiscoverCredit Card TypeCredit Card NumberSecurity CodeName on Card1 - January2 - February3 - March4 - April5 - May6 - June7 - July8 - August9 - September10 - October11 - November12 - DecemberExpiration Month2022202320242025202620272028202920302031Expiration YearBank NameRouting NumberAccount NumberCheckingSavingsBusinessAccount TypeCheck to be made out to Chabad Center of NatickBilling AddressStreet AddressStreet Address Line 2CityState / ProvincePostal / Zip CodePlease SelectUnited StatesAfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanThe BahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChilePeople's Republic of ChinaRepublic of ChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongoCook IslandsCosta RicaCote d'IvoireCroatiaCubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonThe GambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorthern MarianaNorwayOmanPakistanPalauPanamaPapua New GuineaParaguayPeruPhilippinesPitcairn IslandsPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint BarthelemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSomalilandSouth AfricaSouth OssetiaSpainSri LankaSudanSurinameSvalbardSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTristan da CunhaTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamBritish Virgin IslandsUS Virgin IslandsWallis and FutunaWestern SaharaYemenZambiaZimbabweOtherCountryHow did you hear about GEO Jewish After School?I would like to receive news and updates by emailSubmitFor questions or comments, feel free to contact our Hebrew School Director, Chanie Fogelman at [email protected] Option 1Option 2Option 3Should be Empty: This page uses TLS encryption to keep your data secure.