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Hebrew School Registration

Student Information
Child #1*
First NameLast Name
Hebrew Name*
First NameLast Name
Birth Date*
MonthDayYear
School*
Previous Jewish Education
Grade entering*
Child #2
First NameLast Name
Hebrew Name
First NameLast Name
Birth Date
MonthDayYear
School
Previous Jewish Education
Grade entering

Address*

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

Additional notable InformationPlease let us know if there are any allergies or other important information we need to be aware of.
Parents Information
Father's Name*
First NameLast Name
Father's Cell*
Area CodePhone Number
Mother's Name*
First NameLast Name
Mother's Hebrew Name
Mother Jewish by:*
BirthChoice
Mother's Cell*
Area CodePhone Number
Best way to send Hebrew School updates:*
Cell PhoneEmailHandout
I am willing to assist in school activities, please contact me
*
I hereby permit my child (ren) to participate in all school activities and join in school trips on and beyond school properties. In case of emergency, I hereby authorize the school to have my child taken care of by a physician in any way the situation may call for.
Tuition & Payment Options
Tuition $500 per Child, Book Fee $45 per Child
5% Family Discount for second child. 10% discount for Partners of Chabad.
Options*
I will send a check of the full paymentI will be paying the tuition in 2 installmentsI will be paying the tuition with head checks in ten installmentsI will pay by credit card in fullI will pay monthly $54.50 by credit card
Payment
$54.50$545$1090
Total
$0.00

Payment

Credit Card Other

Postal / Zip Code

Country

Should be Empty:

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Hebrew School Chanukah Fair

Updates

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Upcoming Events

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