Registration Form

Student Information
Full Name*

First Name Last Name
Hebrew Name*

First Name Last Name
Birth Date*

Month Day Year
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 Name Last Name
Father's Cell*

Area Code Phone Number
Mother's Name*

First Name Last Name
Mother's Cell*

Area Code Phone Number
E-mail*
Best way to send Hebrew School updates:*

Cell Phone Email Handout
Are the child's natural parents and grandparents Jewish by birth?

Yes No
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 - $800 Pay 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

I would like to receive news and updates by email
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Hebrew School Registration

Student Information

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

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