Student Registration 2023-2024

Hebrew School 2023/24 - 5784

(Do you know of a new family looking for a hebrew school? Refer them to Chabad Hebrew School and receive a $100 tuition credit.)
Number of children being registered:*
Student 1 Profile
Full Name*

First Name Last Name
Hebrew Name
Age*
Birth Date*

Month Day Year
Gender*

FemaleMale
Approximate Time of Birth

Hour Minutes
School*
Grade 2023/2024*
Hebrew Reading Proficiency

NoneSomewhatWell
Previous Jewish Education*

YesNo
Where?
Does your child have an IEP? If yes, please email it in.*

NoYes
CONFIDENTIAL: Does your child have any allergies or medical conditions we should be aware of? If yes, please describe them and indicate special precautions or care needed.
Student 2 Profile
Full Name*

First Name Last Name
Hebrew Name
Age*
Date of Birth*
Approximate Time of Birth

Hour Minutes
School*
Grade 2023/2024*
Hebrew Reading Proficiency

NoneSomewhatWell
Previous Jewish Education*

YesNo
Where?
Does your child have an IEP? If yes, please email it in.*

NoYes
CONFIDENTIAL: Does your child have any allergies or medical conditions we should be aware of? If yes, please describe them and indicate special precautions or care needed.
Student 3 Profile
Full Name*

First Name Last Name
Hebrew Name
Age*
Date of Birth*
Approximate Time of Birth

Hour Minutes
School*
Grade 2023/2024*
Hebrew Reading Proficiency

NoneSomewhatWell
Previous Jewish Education*

YesNo
Where?
Does your child have an IEP? If yes, please email it in.*

NoYes
CONFIDENTIAL: Does your child have any allergies or medical conditions we should be aware of? If yes, please describe them and indicate special precautions or care needed.
Parent Information
Parent 1*

First Name Last Name
Parent 1

Hebrew Name
Mobile*
E-mail*

Address*

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Parent 2

First Name Last Name
Parent 2

Hebrew Name
Mobile
E-mail

Address (If different than parent 1)

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Was the student's biological MATERNAL grandmother born Jewish?*

YesNoOther
Please explain.
Was the student's biological PATERNAL grandmother born Jewish?*

YesNoOther
Please explain.
Have there been any conversions or adoptions in the family?*

YesNo
Please provide details..
Parents are now*

MarriedSeparatedDivorcedFather DeceasedMother DeceasedSingle Parent
I authorize my home telephone and email address to be published in a class list
Primary Contact*

Parent 1Parent 2Both
We grant permission for our children to be photographed in an individual or group picture which may be used by the school for PR purposes (names of children are never released).
Let us know your expectations! I want my child's Hebrew School experience to
Grandparent Information (for nachas reports!)
We would love to send updates about your child to their grandparents throughout the year.
Maternal

First Name Last Name

Address

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

E-mail
Phone Number
Paternal

First Name Last Name

Address

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

E-mail
Month Day Year
at Hour Minutes
Emergency Contacts
Contact 1*

First Name Last Name
Phone Number*

Area Code Phone Number
Relationship
Contact 2*

First Name Last Name
Phone Number*

Area Code Phone Number
Relationship
Tuition
Tuition

$1000 for one student + $50 book & supplies fee + $100 security fee$1950 for two students + $100 book & supplies fee + $200 security fee$2900 for three students + $150 book & supplies fee + $300 security fee2 week trial period - 1 child $50 ($ will be applied towards tuition when you sign up)2 week trial period - 2 children $100 ($ will be applied towards tuition when you sign up)
School Pick-Up

$100 - I would like my child picked up from his/her school and brought to Chabad.
Total

$1150.00

I would like to pay today:Full amount$360.00 minimum$
Recurring Payment

I would like to set up a recurring payment. Please contact me to arrange.
Scholarship

I would like to apply for a scholarship. Please contact us.

Payment

Credit Card Check

Postal / Zip Code

Country

Should be Empty:

This page uses TLS encryption to keep your data secure.

Updates

Lorem ipsum is simply

Lorem Ipsum is simply dummy text of the printing and typesetting industry.

In this Section

● Student Registration 2023-2024

Educate Your Child... Educate a Generation

Student 1 Profile

Student 2 Profile

Student 3 Profile

Parent Information

Grandparent Information (for nachas reports!)

Emergency Contacts

Tuition