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Student Information
Full Name
First NameLast Name
Hebrew Name
First NameLast Name
Age
Birth Date
MonthDayYear
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Address

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Phone Number
Area CodePhone Number
Gender
MaleFemale
Does your Child have a previous Jewish Education
YesNO
If yes please Explain
What School does your child attend?
Grade?
Is the mother of the Child Jewish
YesNO
Were there any conversions in the family?
YesNO
If yes please describe
Any considerations, such as learning disorder or difficulty, the shcool should be aware of?
Parent Information
Fathers Name
First NameLast Name
E-mail
Phone Number
Area CodePhone Number
Cell Number
Area CodePhone Number
Occupation
Mothers Name
First NameLast Name
E-mail
Phone Number
Area CodePhone Number
Cell Number
Area CodePhone Number
Occupation

Address

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Emergency Information
Emergency Contact
Relationship to child
Phone Number
Area CodePhone Number
Mobile Number
Area CodePhone Number
Doctor
Address
Phone Number
Area CodePhone Number
Allergies or other Medical Conditions
As the Parent of legal guardian of above mentioned 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 attend all field trips and outings sponsored by Chabad Hebrew School. By filling in my name and date below I am electronically signing the above form.
Parents Name
Date
Chabad Hebrew School Tuition Agreement
The following is a tuition agreement for the Chabad Hebrew School. The agreement explains tuition fees, payment plans and refund policies. Please it through carefully.
The tuition for the Chabad Hebrew School is $500.00 per Year per Child. ( this includes registration and book fees) Membership not required.
Discounts: There is a 10% sibling discount.There is an additional 10% discount off your entire tuition for every family you successfully introduce to the Chabad Hebrew School. Scholarships are also available, please see Scholarship form. No child will ever be turned away due to lack of funds.
Please Choose from the Following payment options.
Please choose one
Plan A: You may pay the full amount with a check, cash or credit card.Plan B: You pay the annual tuition on a monthly basis by submitting 5 Checks of $100.00 each. All checks should be submitted before the 1st day of shcool.PLac C: You may use your credit card to pay tuition on a monthly basis. . Your credit card will be billed $100.00 monthly Sep - Jan. To do so please Include your credit card info below.

Payment

Credit Card Other

Postal / Zip Code

Country

Monthly for 5 months
$100
One time Charge
$500
Other amount please specify
Should be Empty:

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