This page uses 128 bit SSL encryption to keep your data secure. Please fill out this form as an initial registration for the Chabad Hebrew School. Confirmation of acceptance will be acknowledged only after this registration form is reviewed and an acceptance letter is received. To download a PDF of this form please click here. Student Information Male Female Does you child read basic Hebrew? None Somewhat Well Does your child speak/understand Hebrew? None Somewhat Well Does your child have previous Jewish Education Yes No If yes, please describe: What school does your child attend? Grade entering: Synagogue affiliated with: Is the natural mother of the child Jewish? Yes No Were there any conversions or adoptions in your family? Yes No If yes, please describe: Any considerations, such as learning disorder or difficulty, the school should be aware of? (Confidential): Parent Information Emergency Contact Information Please list two contacts to be used in case of emergencies (other than your home and business numbers). Please send a copy of your insurance card for our files. Up to date with vaccinations? Yes No Date of last tetanus shot: 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. 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 trip on and beyond school properties and allow my child to be photographed while participating in Chabad Hebrew School activities. Accept Do Not Accept Initial here: Chabad Hebrew School Tuition Agreement The following is a tuition agreement for the Chabad Hebrew School. The agreement explains the tuition fees, payments plans and refund policies. The tuition for the Chabad Hebrew School is $600 per year per child (this includes a registration & book fee). Discounts: There is a 10% discount off of the regular tuition for each additional child of the same family. There is a 10% additional discount off your total tuition for each child of another family you successfully introduce to the Chabad Hebrew School. You may choose from the following payment methods: PLAN A: You may pay the entire amount in full with a check, cash or credit card. PLAN B: You may pay the annual tuition on a monthly basis by submitting 10 checks of $60.00 each, dated August through May. All checks must be submitted before the first day of Hebrew School. PLAN C: You may use your credit card to pay the tuition on a monthly basis. Your credit card will be billed $60.00 monthly August through May. To do so please include your credit card number and expiration date at the bottom of this page. Refunds for children withdrawing from school before the end of the school year will be pro-rated up to February 1 provided that the school office is given 30 days written notice and does not include a $50 registration and book fee. Tuition refunds will not be granted to children withdrawing from school after February 1. There are no refunds or credits for days missed due to illness, holidays, or family vacations. Accept Do Not Accept Initial here: Payment Options: VISA MasterCard Discover American Express Check in mail Check or Card No. Check Date or Card Expiration: mm/yyyy / I heard about the Chabad Hebrew School from: This page uses 128 bit SSL encryption to keep your data secure.
