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. 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 ___________________________________, 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 attend all field trips and outings with Chabad Hebrew School. 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 / This page uses 128 bit SSL encryption to keep your data secure.
