2021/22 Online Registration

Welcome to Hebrew School 2021/22

Hebrew School will be held Sunday mornings beginning in the Fall.

Please fill out ALL fields of this form and note that one registration form PER CHILD is needed (please enter n/a if necessary).

We look forward to a wonderful year of learning and growth!

Student Information
First Name*
Last Name*
Hebrew Name*
Birth Date*
MonthDayYear
School*
Grade Entering*
Hebrew Reading Proficiency*
nonesomewhatwell
Previous Jewish Education*
yesno
Where?*
Name of Synagogue Affiliated With*
Parent Information

Address*

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

Phone Number*
Area CodePhone Number
E-mail*
Father's Name*
First NameLast Name
Father's Name
Father's Mobile*
Father's Occupation*
Is Father Jewish?*
yesno
Mother's Name*
First NameLast Name
Mother's Name
Mother's Mobile*
Mother's Occupation*
Is Mother Jewish?*
yesno
Emergency Information
Emergency Contact 1*
Relationship to Student*
Phone Number*
Area CodePhone Number
Emergency Contact 2*
Relationship to Student*
Phone Number*
Area CodePhone Number
Doctor's Name*
Doctor's Phone Number*
Area CodePhone Number
CONFIDENTIAL: Does your child have any allergies or other medical condition we should be aware of? If yes, please describe them and indicate special precautions or care needed.
Authorization
As the parent(s) or legal guardian of the above 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 participate in all school activities, join in class and school trips on and beyond school properties and allow my child to be photographed while participating in Chabad Hebrew School activities and that these pictures may be used for marketing purposes.
I accept
Name*
Initials*
Date*
MonthDayYear
Tuition Payment
Tuition: $645
Early bird discount before July 1: $595
Payment Options*
Pay in full, todayPay in 9 Monthly installments, Starting Sept. 1st
Total Due Today
$0.00 USD

Payment*

Credit Card Check

Postal / Zip Code

Country

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Student Information