Registration Form

Student Information
Full Name*
First NameLast Name
Hebrew Name*
First NameLast Name
Birth Date*
MonthDayYear
School*
Previous Jewish Education
Grade entering*

Address*

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

Does your child have any allergies?*
Additional notable Information
Terms of Agreement.*
Chabad Hebrew School has my permission to seek emergency medical attention for my child if unable to contact me. I understand that Chabad Hebrew School and its designated teachers are not legally or financially liable for any claim arising from any consent given in good faith in connection with such diagnosis or advised treatment. I agree that my child may participate in all school activities and school outings (with advance notice and information) and may be photographed for purpose of school advertising, for example in local newspapers, social media, school brochures, etc.
Parents Information
Father's Name*
First NameLast Name
Father's Cell*
Area CodePhone Number
Mother's Name*
First NameLast Name
Mother's Cell*
Area CodePhone Number
Best way to send Hebrew School updates:*
Cell PhoneEmailHandout
Are the child's natural parents and grandparents Jewish by birth?
YesNo
If no, or if any conversions, please explain:Chabad is committed to serving the community in accordance with the Code of Jewish Law
Payment ( *No child will be turned away due to lack of funds)
Payment Plan:Includes registration & supplies. (Does not include monthly workshop open to community)
Pay in Full - $800Pay in 4 Installments (Card charged on 1st of Sept., Nov., Feb. & April.)10 Post dated checks (Contact office)Alternate payment plan has been discussed
Terms of Agreement.*
Please understand that this is an ANNUAL fee you are agreeing to, broken down to the above options for your convenience. The fee remains the same regardless of holidays, vacations, missed classes due to sports, illness, etc. I agree to abide by the rules and policies of Chabad Hebrew School.
Total
$0.00

Payment

Credit Card Other

Postal / Zip Code

Country

Should be Empty:

Hebrew School Registration

Student Information

Parents Information

Payment ( *No child will be turned away due to lack of funds)

Synagogue Services

Adult Education

School and Youth

Mommy and Me

Women's Events

Visitors Center