Registration Form

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.

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 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

Hebrew School Registration

Student Information

Parents Information

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

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