Returning Student Registration

Family Name

First NameLast Name

Number of children being registered*

Student 1 Name*

First NameLast Name

Student 1 Hebrew Name

Student 1 Grade Entering*

Student 2 Name

First NameLast Name

Student 2 Hebrew Name

Student 2 Grade Entering

Student 3 Name

First NameLast Name

Student 3 Grade Entering

Student 3 Hebrew Name

Has any information changed from last year? (Such as address, email, contact info)*

YesNo

If yes please list:

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

Please send a copy of Immunizations.

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

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: $75 Per child
Security Fee: $60 Per family

TRACK 2: Virtual Hebrew School - Ages 5-13
Wednesday afternoons
Registration Fee: $75 Per child
Supplies Fee: $25/month Per child

TRACK 1: Please select the day/s your child will be attending.

Sunday $895 + Reg. & Security FeeWednesday $895 + Reg. & Security FeeMonday $895 + Reg. & Security FeeSunday & Monday $990 + Reg. & Security FeeMonday & Wednesday $990 + Reg. & Security Fee

TRACK 2: Virtual

Wednesday $800 + 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

Name of new family referral

All applications will automatically be charged the $75 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 2022I 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 $250Sponsor a students for a year $650I 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:

**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.

Tuition and Dates

Payment Options