Returning Registration

How many children are you registering today?

1
2
3

Child 1 Name*

First Last

Hebrew Name

DOB*

Age*

Gender*

Boy
Girl

School*

Grade Entering*

Second Child

Child 2 Name*

First Last

Hebrew Name

DOB*

Age*

Gender*

Boy
Girl

School*

Grade Entering*

Third Child

Child 3 Name*

First Last

Hebrew Name

DOB*

Age*

Gender*

Boy
Girl

School*

Grade Entering*

Parent Information

Father's Name*

First Last

Hebrew Name

Home Phone

Father's Cell*

Father's Email*

Occupation*

Mother's Name*

First Last

Hebrew Name

Home Phone

Mother's Cell*

Mother's Email*

Occupation*

Address*

Street Address Address Line 2 City State ZIP Code

Persons to be contacted in case of an emergency when parents cannot be reached. Please provide at two contacts.

Name 1*

First Last

Phone*

Relationship to child*

Name 2

First Last

Phone

Relationship to child

Does your child attend any special education program in public school?*

Yes
No

Please explain*

CONFIDENTIAL: Does your child have any allergies or other medical condition, require medication, or any special abilities or disabilities we should be aware of?*

Yes
No

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 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*

Payment Options

Early Bird Special! Are you registering before August 10?*

No
Yes

Tuition Plans - 1 Child

Plan A: One Full Tuition Payment - $1,250
Plan B: Half Now ($625) and the other half will be due on December 5th

Tuition Plans - 1 Child (Early Bird)

Plan A: One Full Tuition Payment - $1,150
Plan B: Half Now ($575) and the other half will be due on December 5th

Tuition Plans - 2 Children

Plan A: Full Tuition Payment - $2,500
Plan B: Half Now ($1250) and the other half will be due on December 5th

Tuition Plans - 2 Children (Early Bird)

Plan A: Full Tuition Payment - $2,300
Plan B: Half Now ($1150) and the other half will be due on December 5th

Tuition Plans - 3 Children

Plan A: Full Tuition Payment - $3,750
Plan B: Half Now ($1875) and the other half will be due on December 5th

Tuition Plans - 3 Children (Early Bird)

Plan A: Full Tuition Payment - $3,450
Plan B: Half Now ($1725) and the other hald will be due on December 5th

Payment Method*

Check
Credit Card

Please check one option.

Billing Address For Payment

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Credit Card

Card Details

Cardholder Name

Total

$0.00

Name*

Initials*

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

Returning Students:

Second Child

Third Child

Parent Information

Payment Options

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