Hebrew School Registration Form

Sep 2018- June 2019

                               

Part I: Student Information

  
  
Gender: Male    Female 
  
 
  


Part II: Parent's Information

   
Jewish from birth? Yes   Not Jewish
Converted-Please submit copy of conversion papers
 
Jewish from birth? Yes   Not Jewish 
Converted-Please submit copy of conversion papers
  
 


Part III: Religious & Educational History

Is this your child a returning student
Does your child read Hebrew: 
 No   Somewhat   Well
Does your child speak/understand Hebrew:
 No   Somewhat   Well
Previous Hebrew Education: 

Does your child have any learning difficulties with general studies: 
 Yes    No
If yes, please describe: 


Part IV: Medical Information (confidential)

 
Up to date with vaccinations: Yes   No
Is there any special medical or other information (allergies, medication) regarding your child that our school should be aware of?

Person to be contacted in case of emergency, when parents cannot be reached:
 

Medical Release Form
I hereby give consent to the administration of the Chai Center Hebrew School to take whatever medical measures they deem necessary, at my expense, for my child in the event of a medical emergency.
Accept   Do not accept


 

Part IV: Program & Payment Information

Hebrew School Ages 5-13,  Sun. 10:00pm-12:00pm
     Monthly  Tuition: $69 One Child $125 Two children 
(includes supplies/book fee)10 Payments 

   

Optional - Synagogue Membership :$50 Per month

While we will maintain Chabad’s policy that everyone is welcome to our shul regardless of payment, we recognize that membership also has advantages.

   

Please select payment plan:

 

                                          Payment Method

 

 

A Monthly check

 

 

Please charge my credit card monthly

 

 


If paying by check or cash, full monthly payment must be submitted to the school office before any child will be permitted to attend classes. Checks should be payable to Chabad synagogue.

Credit Card Information
Visa   Master Card   Amex
Credit Card number:  
Expiration:

To register in person stop the synagogue any time to pick up form