Family Name First Name Last Name Number of children being registered* 123 Student 1 Name* First Name Last Name Student 1 Hebrew Name Grade Entering* Birth Date* 1 - January2 - February3 - March4 - April5 - May6 - June7 - July8 - August9 - September10 - October11 - November12 - December Month12345678910111213141516171819202122232425262728293031 Day202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920 Year Student 2 Name First Name Last Name Student 2 Hebrew Name Student 2 Grade Entering Birth Date 1 - January2 - February3 - March4 - April5 - May6 - June7 - July8 - August9 - September10 - October11 - November12 - December Month12345678910111213141516171819202122232425262728293031 Day202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920 Year Student 3 Name First Name Last Name Student 3 Hebrew Name Student 3 Grade Entering Birth Date 1 - January2 - February3 - March4 - April5 - May6 - June7 - July8 - August9 - September10 - October11 - November12 - December Month12345678910111213141516171819202122232425262728293031 Day202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920 Year 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 Code Phone Number Parent E-mail* Address Street Address Street Address Line 2 City State / Province Postal / Zip CodePlease SelectUnited StatesAfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanThe BahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChilePeople's Republic of ChinaRepublic of ChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongoCook IslandsCosta RicaCote d'IvoireCroatiaCubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonThe GambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorthern MarianaNorwayOmanPakistanPalauPanamaPapua New GuineaParaguayPeruPhilippinesPitcairn IslandsPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint BarthelemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSomalilandSouth AfricaSouth OssetiaSpainSri LankaSudanSurinameSvalbardSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTristan da CunhaTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamBritish Virgin IslandsUS Virgin IslandsWallis and FutunaWestern SaharaYemenZambiaZimbabweOther Country Phone Number Area Code Phone Number Father's Full Name First Name Last Name Father's Cell Phone Number Area Code Phone Number Mother's Full Name First Name Last Name Mother's Cell Phone Number Area Code Phone 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 Name Last Name Phone Number Area Code Phone Number Pediatrician First Name Last Name Phone Number Area Code Phone 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 understand that in the event I need to take my child out of Hebrew School, before January 1st cost will be prorated, after January 1st there will be no refunds. * I have read & agree to all the above. Signature* Date* Month Day Year 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 Sunday: Ages 5-13 Monday & Wednesdays: Ages 6-13 Sunday 9:45-11:45 am Mondays 4:30-6:30 pm Wednesdays: 4:30-6:30 pm Registration Fee: $100 Per child Security Fee: $90 Per family Supplies & Book Fee: $80 Per Child Please select the day/s your child will be attending. Sunday $990 + Reg., Supplies, & Security FeeWednesday $990 + Reg., Supplies, & Security FeeMonday $990 + Reg., Supplies, & Security FeeSunday & Monday $990 + Reg., Supplies for 2 days, & Security FeeMonday & Wednesday $990 + Reg., Supplies for 2 days, & Security Fee Discount Options Returning Student Early Bird Registration - $125 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 OptionsAll registration forms must be submitted with the registration fee and full payment or payment plan. Tuition payments will begin processing in August. All applications will automatically be charged the $100 Registration fee. I would like to make the remaining payment by: Please select.* Pay in full by credit cardQuarterly payments by credit card.I will mail in check/s for the remaining balance prior to August 15th (if checks are not received the credit card on file will be charged quarterly) We would like to become a Chabad Youth Network Partner Family. By partnering in all of Chabad Youth activities.* YesNo Monthly membership/partnership opportunities include a monthly donation of: Chabad Youth Partner Families receive discounts to Chabad Youth Events & Holiday Packages $36 Bronze Partnership$101 Silver Partnership$180 Gold Partnership$250 Platinum Partership$360 Diamond Partnership We will begin having security at CHS. Mandatory Security Fund ($50 minimum per family required) $50$90$180 Total $0.00 Payment Credit Card We accept Visa, MasterCard, American Express, Discover Credit Card Number Security Code Name on Card1 - January2 - February3 - March4 - April5 - May6 - June7 - July8 - August9 - September10 - October11 - November12 - December Expiration Month2024202520262027202820292030203120322033 Expiration YearBilling Address Street Address City State / Province Postal / Zip CodePlease SelectUnited StatesAfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanThe BahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChilePeople's Republic of ChinaRepublic of ChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongoCook IslandsCosta RicaCote d'IvoireCroatiaCubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonThe GambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorthern MarianaNorwayOmanPakistanPalauPanamaPapua New GuineaParaguayPeruPhilippinesPitcairn IslandsPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint BarthelemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSomalilandSouth AfricaSouth OssetiaSpainSri LankaSudanSurinameSvalbardSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTristan da CunhaTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamBritish Virgin IslandsUS Virgin IslandsWallis and FutunaWestern SaharaYemenZambiaZimbabweOther 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 ClubTeens - Cteen (humanitarian/social program for HS students)Adults - JBN - Jewish Business Network Please note: As it takes time for the office to process the forms. All forms must be received no later than September 5th in order for your child to begin Hebrew School on time. Submit Should be Empty: This page uses TLS encryption to keep your data secure.