NEW STUDENTS REGISTRATION FORM If you have any questions or concerns you would like to discuss with us, please feel free to call us at please feel free to call us at 760-806-7765 or email [email protected]How many children would you like to register?*CHILD 1 INFORMATIONFull Name*First NameLast NameHebrew NameAgeBirth Date*1 - January2 - February3 - March4 - April5 - May6 - June7 - July8 - August9 - September10 - October11 - November12 - DecemberMonth12345678910111213141516171819202122232425262728293031Day2022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920YearTime of Day:To calculate Jewish Birth date123456789101112Hour000102030405060708091011121314151617181920212223242526272829303132333435363738394041424344454647484950515253545556575859MinutesAMPM Gender*MaleFemaleGrade entering in September*PreschoolKindergarten1st2nd3rd4th5th6th7th8thPrevious Jewish EducationHebrew Reading ProficiencyDoes your child have any allergies?*CHILD 2 INFORMATIONFull Name*First NameLast NameHebrew NameAgeBirth Date*1 - January2 - February3 - March4 - April5 - May6 - June7 - July8 - August9 - September10 - October11 - November12 - DecemberMonth12345678910111213141516171819202122232425262728293031Day2022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920YearTime of Day:To calculate Jewish Birth date123456789101112Hour000102030405060708091011121314151617181920212223242526272829303132333435363738394041424344454647484950515253545556575859MinutesAMPM Gender*MaleFemaleGrade entering in September*PreschoolKindergarten1st2nd3rd4th5th6th7th8thPrevious Jewish EducationHebrew Reading ProficiencyDoes your child have any allergies?CHILD 3 INFORMATIONFull Name*First NameLast NameHebrew NameAgeBirth Date*1 - January2 - February3 - March4 - April5 - May6 - June7 - July8 - August9 - September10 - October11 - November12 - DecemberMonth12345678910111213141516171819202122232425262728293031Day2022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920YearTime of Day:To calculate Jewish Birth date123456789101112Hour000102030405060708091011121314151617181920212223242526272829303132333435363738394041424344454647484950515253545556575859MinutesAMPM Gender*MaleFemaleGrade entering in September*PreschoolKindergarten1st2nd3rd4th5th6th7th8thPrevious Jewish EducationHebrew Reading ProficiencyDoes your child have any allergies?ADDRESSAddress*Street AddressStreet Address Line 2CityState / ProvincePostal / Zip CodePlease SelectUnited StatesAfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanThe BahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChilePeople's Republic of ChinaRepublic of ChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongoCook IslandsCosta RicaCote d'IvoireCroatiaCubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonThe GambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorthern MarianaNorwayOmanPakistanPalauPanamaPapua New GuineaParaguayPeruPhilippinesPitcairn IslandsPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint BarthelemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSomalilandSouth AfricaSouth OssetiaSpainSri LankaSudanSurinameSvalbardSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTristan da CunhaTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamBritish Virgin IslandsUS Virgin IslandsWallis and FutunaWestern SaharaYemenZambiaZimbabweOtherCountryPARENT'S INFORMATIONMarital StatusMarriedSingleDivorcedSeparatedFather's Name*First NameLast NameFather's Occupation*Father Cell*Area CodePhone NumberFather's E-mail*Is the biological father of the child Jewish?*Yes by BirthYes by convesionNoMother's Name*First NameLast NameMother's Occupation*Mother Cell*Area CodePhone NumberMother's E-mail*Is the biological mother of the child Jewish?*Yes by BirthYes by ConversionNoFAMILY INFORMATIONHave there been any conversions in your family?*YesNoHave there been adoptions in your family?*YesNoIf yes, please explain?*EMERGENCY INFORMATION & TERMSEmergency Contact*First NameLast NameRelationshipPhone Number*Area CodePhone NumberDoes 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.Additional notable informationHow did you hear about Chabad Hebrew SchoolTerms of Agreement**As the parent(s) or legal guardian(s) 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.TUITIONTuition: $995 per child (supplies, snacks & book fee included). | Monday's 4pm - 6pm Early-bird special: $895 for registration completed by September 6 Sibling Discount: 10% discount for the second child.* Every Jewish child deserves a quality education. Please don't hesitate to reach out to us for a scholarship or payment plan that can work for your family. No child will be turned away due to lack of funds.If you are in a position to contribute to our scholarship fund, please consider a $180-$995 or any amount donation.ENROLLMENTAfter you have successfully submitted your application it will be subject to review. We will reach out to schedule a follow up call to discuss your application and confirm it's approval. Once approved an invoice will be sent to complete your child's enrollment. SubmitShould be Empty: This page uses TLS encryption to keep your data secure.