Returning Student Registration

Family Name
First NameLast Name
Number of children being registered*
Student 1 Name*
First NameLast Name
Student 1 Hebrew Name
Grade Entering*
Birth Date*
MonthDayYear
Student 2 Name
First NameLast Name
Student 2 Hebrew Name
Student 2 Grade Entering
Birth Date
MonthDayYear
Student 3 Name
First NameLast Name
Student 3 Hebrew Name
Student 3 Grade Entering
Birth Date
MonthDayYear
Has any information changed from last year? (Such as address, email, contact info)*
YesNo
If yes please list:
Any comments or suggestions for the coming hebrew school year?
I would like to be added to the Hebrew School Whatsapp Group to stay informed of events & updates
YesNo
If you answered yes, Phone Number to add to whatsapp
Area CodePhone Number

Address

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

Phone Number
Area CodePhone Number
Father's Full Name
First NameLast Name
Father's Cell Phone Number
Area CodePhone Number
Mother's Full Name
First NameLast Name
Mother's Cell Phone Number
Area CodePhone Number
Was the child's mother born Jewish?
YesNo
Is the child's father Jewish?
YesNo
Was the child's mother's mother born Jewish?
YesNo
Are there any adoptions in the family?
YesNo
Are there any conversions in the family?
YesNo
If you answered yes to either one please specify:
Mother's E-mail
Father's E-mail
Which email would you like us to contact?
MotherFatherBoth
Any behavioral information we should be aware of?
Emergency Contact Besides Parent
First NameLast Name
Phone Number
Area CodePhone Number
Pediatrician
First NameLast Name
Phone Number
Area CodePhone Number
Medication child is taking on a regular basis
Any special medical circumstances or allergies
I authorize Chabad Hebrew School to take my child on school trips. (You will be notified prior to any trips)
I authorize Chabad Hebrew School to take pictures/video of my child and use them for publicity purposes (i.e., Brochures, Websites)
In the event I cannot be reached, I hereby grant permission to the staff of Chabad Hebrew School to treat and/or provide a physician or hospital to give emergency treatment to my child.
*
I have read & agree to all the above.
Signature*
Date*
MonthDayYear
Tuition and Dates
Hebrew School - Ages 5-13
Mondays & Wednesdays 4:30-6:30 pm
Sunday 9:45-11:45 am.
$895 Tuition + $75 Nonrefundable Registration/Book Fee
Dates & Times
TRACK 1: In Person Hebrew School - Ages 5-13
Sunday 9:45-11:45 am
Mondays 4:30-6:30 pm
Wednesdays: 4:30-6:30 pm

Registration Fee: $50 Per child
Security Fee: $60 Per family
Supplies & Book Fee: $75 Per Child

TRACK 2: Virtual Hebrew School - Ages 5-13
Wednesday afternoons
Registration Fee: $50 Per child
Supplies & Delivery Fee: $40/month Per child
TRACK 1: Please select the day/s your child will be attending.
Sunday $895 + Reg., Supplies, & Security FeeWednesday $895 + Reg., Supplies, & Security FeeMonday $895 + Reg., Supplies, & Security FeeSunday & Monday $995 + Reg., Supplies, & Security FeeMonday & Wednesday $995 + Reg., Supplies, & Security Fee
TRACK 2: Virtual
Wednesday $895 + Reg. & Supplies Fee
Discount Options
Returning Student Early Bird Registration - $75 off Tuition (Register before July 8th)Refer a new family – $100 discount (can be used to refer 1 family per year)Sibling discount – $100 discount off second childStudents going into 2nd grade or younger - $200 off Tuition (Can not be combined with other discounts)
Name of new family referral
Payment Options
All registration forms must be submitted with the registration fee and full payment or payment plan.
All applications will automatically be charged the $50 Registration fee. I would like to make the remaining payment by: Please select.*
Pay in full by credit cardMonthly payments by credit card, through January 2023I will mail in check/s for the remaining balance prior to August 1st
I would like to donate to the Hebrew School education scholarship fund:
Sponsor a student for a month $100Sponsor a student for 3 months $300Sponsor a students for a year $895I would not like to donate at this time.
Other amount:
$
We will begin having security at CHS. Mandatory Security Fund ($50 minimum per family required)
$50$90$180
Total
$0.00

Payment

Credit Card

Credit Card Type
Credit Card Number	Security Code
Name on Card
Expiration Month	Expiration Year

Billing Address

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Country

I would like more information on the following programs:
Youth - Gan Israel Day CampPre-Teens - Bar/Bat Mitzvah Lesson Pre- Teens Bar/ Bat Mitzvah ClubPre-Teens/Teens - Cteen Junior (Jewish Club for 7th & 8th graders)Teens - Cteen (humanitarian/social program for HS students)Teens - JLI Teens/Hebrew HighTeens - Friendship Circle - Teen volunteer opportunitiesAdults - Adult EducationAdults - JBN - Jewish Business NetworkAdults - Smiling on SeniorsAdults - Synagogue InformationAdults - JWC - Jewish Women's Circle
**YOU WILL BE NOTIFIED VIA EMAIL UPON APPLICATION ACCEPTANCE**
Please note: As it takes time for the office to process the forms. All forms must be received no later than August 15th in order for your child to begin Hebrew School on time.
Should be Empty:

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Educate Your Child... Educate a Generation

Tuition and Dates

Payment Options