We are currently accepting application forms for the 2018-2019 school year. Please fill out ALL fields of this form. If you have any questions or concerns you'd like to discuss with us, please contact us. We look forward to a wonderful year of learning and growth.

*The Director will interview new families after registration is submitted, before acceptance is finalized.
** Scholarship applicants must complete Registration and the Scholarship Application
*** Please not that there is an additional application process for Bar/Bat Mitzvah, that is distinct from Hebrew School.

Student Profile
CHILD #1
Last Name
First Name
Hebrew Name
Gender
Male Female
Date of Birth
School
Grade
Previous Jewish education?
Yes No
If Yes please describe
Hebrew Reading Proficiency: None Somewhat Well

Is the child's mother Jewish by birth? Yes No

Have there been any conversions or adoptions in the family? Yes No

If yes, please explain
CHILD #2
Last Name
First Name
Hebrew Name
Gender
Male Female
Date of Birth
School
Grade
Previous Jewish education?
Yes No
If Yes please describe
Hebrew Reading Proficiency: None Somewhat Well

Is the child's mother Jewish by birth? Yes No

Have there been any conversions or adoptions in the family? Yes No

If yes, please explain
CHILD #3
Last Name
First Name
Hebrew Name
Gender
Male Female
Date of Birth
School
Grade
Previous Jewish education?
Yes No
If Yes please describe
Hebrew Reading Proficiency: None Somewhat Well

Is the child's mother Jewish by birth? Yes No

Have there been any conversions or adoptions in the family? Yes No

If yes, please explain
Parent Information

Father

Title/First Name
Last Name
Work Phone
Cell Phone
Occupation
Email
Mother
Title/First Name
Last Name
Work Phone
Cell Phone
Occupation
Email
Parents
Address
City/State/ Zip
Home Phone
Emergency Information
Emergency 1
Name
Phone #
Relation
Emergency 2
Name
Phone #
Relation
Family Physician    
Doctor's Name
Doctor's Address
Doctor's Phone #
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.

Tuition Fees
$600 tuition, $50 Registration & Book Fee - per child.
I would like to pay a one time payment of $650
I would like to make four payments of $150 (due in Sept. Nov. Dec. Jan.) , and pay the $50 book fee now. (Chabad must receive post-dated checks or have a CC on file, upon commencement.)
I need to discuss an alternative payment plan
Payment Information
Card Number
Name on Card
Expiration Date
Security Code
What's This?
Billing Address
Billing Zip
Disclaimer
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: