Student Registration form 2018- 2019   

Student Information (child 1) 

     
    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: 

   

 

Student Information (child 2) 

      
     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:  
    

 

 

 

Parent Information 

     
   

  
   

    
   
 
    

Are the natural parents of the child (ren) Jewish   Yes No  

Were there any conversions or adoptions in your family history   Yes No  
if yes please explain :

   
 


Emergency Contact Information 
Please list two contacts to be used in case of emergencies (other than your home and business numbers).
 
   
  
 

   
  
  

  
  

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.




Accept 
  Do Not Accept 
Initial here:  

 
 

Tuition Information 

The following is a tuition agreement for the Chabad Hebrew School. A full payment plan must be submitted to the school office before the school year begins.No child will be turned away for lack of funds. 

Tuition fee:  $750 per child
Includes Registration, Books, Supplies, Snack & Yearly Hebrew School family Shabbat dinner. 

Discounts: 

Join the Partnership club and save $100! 
Click here for details.

 

 
 

Payments Plans 

Bill me the full payment of $750 per child through  the credit card given below

You may use my credit card to pay the tuition through the year. Your credit card will be billed  
5 times $150 per child for the overall tuition every month, September through January. 

I will pay the full payment of $750 per child by cash 
before the beginning of the school year


   
VISA MasterCard American Express  

 Card No.
   

Card Expiration: mm/yyyy
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