We are currently accepting application forms for the 2020-2021 school year. Please fill out ALL necessary fields of this form. If you have any questions or concerns you'd like to discuss with us, please contact us.

RETURNING CHILDREN: only need to fill out student profile, sign on bottom & payment info (Please update any important information that changed).

We look forward to a wonderful year of learning and growth.

Student Profile

Tuesdays 4:15 - 6:15 PM

OPTIONAL - additional Thursday & Sunday Class

Student 1 Student 2 Student 3
Student's Full Name
Student's Full Name
Student's Full Name
Hebrew Name
Hebrew Name
Hebrew Name
Date of Birth
Date of Birth
Date of Birth
Gender
Gender
Gender
School Attending
School Attending
School Attending
Entering Grade
Entering Grade
Entering Grade
Hebrew Reading Proficiency
None Somewhat Well		 Hebrew Reading Proficiency
None Somewhat Well		 Hebrew Reading Proficiency
None Somewhat Well
Previous Jewish Education
Yes No		 Previous Jewish Education
Yes No		 Previous Jewish Education
Yes No
Where?
Where?
Where?

 Was the child's biological mother born Jewish? 

Were there any conversions or adoptions in the family?

  
If Yes please describe:
Parent Information

 
Home Phone

Father's Name
Father's Cel
Father's Email Address
Mother's Name
Mother's Cel
Mother's Email
Address

City
State
Zip

Are parents Married ?  Divorced?   Other/explain 

Emergency Information
 
Emergency Contact 1
Phone
Emergency Contact 2
Phone

 

Doctor
Address
Phone

CONFIDENTIAL: Does your child receive additional resources in school ? (Ie. ADD / ADHD).

Does your child have allergies or other medical condition we should be aware of?

Please describe above and indicate special precautions or care needed.

Payment Information
Hebrew School, $1,300 annual tuition, including Book Fee

Amount

$1,300 (1 child) $2,600 (2 children)  $3,705 (3 children includes 5% discount)  OPTIONAL Thursday Additional $500 (per kid)     OPTIONAL Thursday Additional $500 (per kid) 

$150 is non refundable registration fee 
  Pay by Credit Card
Credit Card Number
Billing Address
CVV
Expiration Date
  or Pay by Electronic Check
Amount
Account type
Account number
Routing number
Name on account

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 in an emergency. 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 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.

I Accept

Name: Initials:

We look forward to a wonderful year of learning and growth!