Returning Student Registration

Family Name

First Name Last Name
Number of children being registered*
Student 1 Name*

First Name Last Name
Student 1 Hebrew Name
Grade Entering*
Birth Date*

Month Day Year
Student 2 Name

First Name Last Name
Student 2 Hebrew Name
Student 2 Grade Entering
Birth Date

Month Day Year
Student 3 Name

First Name Last Name
Student 3 Hebrew Name
Student 3 Grade Entering
Birth Date

Month Day 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

Address

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

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: $90 Per family
Supplies & Book Fee: $100 Per Child

TRACK 2: Virtual Hebrew School - Ages 5-13
Wednesday afternoons
Registration Fee: $75 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. Fee
Discount Options

Returning Student Early Bird Registration - $125 off Tuition (Register before June 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 $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 2024I will mail in check/s for the remaining balance prior to September 1st (if checks are not received the credit card on file will be charged)
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

We accept Visa, MasterCard, American Express, Discover
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.
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Tuition and Dates

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