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New Student Registration Form

New Student Registration Form

Hebrew School Registration Form

2017-2018/5778

If you're child is a returning student please fill out our quick and easy registration form here.

Part I: Student’s Information

Last Name:

First Name:

Male Female

(Child’s) e-mail:

Address: City:

State: Zip Code: Phone:

Day School:

Grade: Age:

Birthday:

Part II: Parents’ Information

Father’s Full Name:

Mother’s Full Name:

Home phone: Home Fax:

Work phone (Father): Cell (Father):

E-mail (Father):

Work phone (Mother): Cell (Mother):

E-mail (Mother):

Part III: Family

Brother: D.O.B:

Brother: D.O.B:

Brother: D.O.B:

Sister: D.O.B:

Sister: D.O.B:

Sister: D.O.B:

Part V: Hebrew Education

Father’s Hebrew Name:

Mother’s Hebrew Name:

Student’s Hebrew Name:

Does your child have any learning difficulties with general studies?

Yes No

If yes, please describe:

Is the natural mother of the child Jewish? Yes No

Where there any conversions or adoptions in the family? Yes No

If yes, who?

Part VI: Medical Information

Health insurance:

Is there any medical or other information (allergies, etc.) regarding your child that our school should be aware of?


Part VII: Payment Information

Please check your choice for method of payment:

Annual Fee (K-7th grade): Sunday 10-12:30pm

Members:

$850 per year (paid in full)

$425 (2 payments)

$142 (6 payments)

Non Members:

$1200 per year (paid in full)

$600 (2 payments)

$200 (6 payments)

There is a $50 registration fee ($25.00 off if submitted by Sunday May 21st) per child and a $30 book fee per child.

Family Discount: 10% off each additional child.

There will be a 3% ‘bank charge’ when using your credit card

Plan A: I am paying the entire amount now, which entitles me to a $30 discount off regular tuition.

Plan B: Please automatically charge my credit card at the beginning at each month

Plan C: I will pay 10 post dated checks for the beginning of each month, dated September through June. All checks must be submitted by the 1st day of Hebrew School.

 

Total  
Name on Card CC #
Exp Date CVV Code
Address Zip

(3% charge will be applied to all credit card transactions)

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. If for any reason you decide to cancel during the year, you will be refunded/ not charged from the beginning of the next month. There are no refunds after May 1st. I understand that by recieving the early bird discount my first payment is non-refundable.

 

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