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Register

Register

Enrollment Form

2016-2017

We are currently accepting application forms for the 2015-2016 school year.

Please fill out ALL fields of this form. If you have any questions, 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
First Name
Last Name
Hebrew Name
Age
DOB
School
Grade Entering
Hebrew Reading Proficiency None Somewhat Well
Previous Jewish Education Yes No
Where?


Family Information
My child is a
Are the natural father and mother of the child Jewish? Yes No
If no, please explain.
Have there been any conversions or adoptions in the family? Yes No
If yes, please explain.
Are you interested in carpooling? Yes No
If yes, can we give your number to other parents? Yes No

Parent Information
Father's Name
Mobile
Mother's Name
Mobile
Home Phone
Address
City
Zip
Email*
* Email address allows us to communicate in the most efficient and economical manner. We do not use your address for other puropses.

Emergency Information
Emergency Contact 1
Phone
Relationship
Emergency Contact 2
Phone
Relationship

Medical Information

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.


Payment Details
 


Included is $560 (Tuition plus Book Fee)
Included is $290 (1/2 Tuition/ Book & Material Fee) I will pay balance (270) on Jan. 1

Please contact Chani if you are in need of tuition assistance.

Payment Amount
Card Type
Card Number
Expiration Date
Cvv Code

Terms of Agreement

In the event of an emergency, Chabad Hebrew School has my permission to arrange for any necessary first-aid or care by a licensed physician/first-aid worker. Chabad Hebrew School has my permission to use my child's photo in its publicity materials. I have completed the Enrollment Form.

I Accept

Name: Initials:

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