We are currently accepting application forms for the 2019-20 school year. Please fill out ALL fields of this form. If you have any questions or concerns you'd like to discuss, please contact us.

Please note that one registration form per child is needed.

We look forward to a wonderful year of learning and growth.

Student Profile
 
Name
Last
Hebrew Name
Date of Birth
Time of Day
School
Grade Entering
Hebrew Reading Proficiency None Somewhat Well
Previous Jewish Education Yes No
Where?
Is the biological mother of the child Jewish?
Were there any conversions or adoptions in your family?
If there has been a conversion please send in a copy of Certificate.

 

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

 

Emergency Information (If we can't reach you)
 
Emergency Contact 1
Phone
Emergency Contact 2
Phone

 

Payment Information
 
How would you like to pay? Credit Card Check
Payment Plan
**All checks must be predated and received before the first day of Hebrew School

Full [Paid by 9/14]
2 Payments [Dated 9/14 and 1/11]

My billing address is the same as my home address
Card Type
Card Number
Address
City
Billing Zip Code
Exp. Date
CVV

 

 

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.



 

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 hereby give permission for my child to participate in all school activities, join in class and school trips on and beyond school properties and allow my child to be photographed while participating in Chabad Hebrew School activities and that these pictures may be used for marketing purposes.

I Accept

Name: Initials:

We look forward to a wonderful year of learning and growth!