New Student Registration

Registration: New Student

How many students are you registering today?

Child 1 Information

First Name

Last Name

Jewish Name

Date of Birth

Gender

What school does child 1 attend?

Entering Grade

Does this child read Hebrew?

Does this child understand basic Hebrew?

Does this child have an IEP (individualized education plan) in school?

Child 2 Information

First Name

Last Name

Jewish Name

Date of Birth

Gender

What school does child 2 attend?

Entering Grade

Does child 2 read Hebrew?

Does child 2 understand basic Hebrew?

Does child 2 have an IEP (individualized education plan) in school?

Child 3 Information

First Name

Last Name

Jewish Name

Date of Birth

Gender

What school does child 3 attend?

Entering Grade

Does child 3 read Hebrew?

Does child 3 understand basic Hebrew?

Does child 3 have an IEP (individualized education plan) in school?

Child 4 Information

First Name

Last Name

Jewish Name

Date of Birth

Gender

What school does child 4 attend?

Entering Grade

Does child 4 read Hebrew?

Does child 4 understand basic hebrew?

Does child 4 have an IEP (individualized education plan) in school?

Parent Information

Father’s First Name

Father’s Last Name

Father’s Cell Phone

Father’s Email Address

Is the father Jewish?

Mother’s First Name

Mother’s Last Name

Mother’s Cell Phone

Mother’s Email Address

Is the mother Jewish?

Home Address

Street Address

City

State

Zip Code

Please specify any medical conditions or allergies we should be aware of

Emergency Contact Name

Emergency Contact Phone Number

How do you want to pay?

Make 1 Single Payment

One time payment of $800.00

Pay in 10 Installments

$80.00 for each month, for 10 installments

How do you want to pay?

Make 1 Single Payment

One time payment of $1,600.00

Pay in 10 Installments

$160.00 for each month, for 10 installments

How do you want to pay?

Make 1 Single Payment

One time payment of $2,400.00

Pay in 10 Installments

$240.00 for each month, for 10 installments

How do you want to pay?

Make 1 Single Payment

One time payment of $3,200.00

Pay in 10 Installments

$320.00 for each month, for 10 installments

One Time Security Fee (per family): $80. Upon completing this form, you’ll automatically receive an email with a link to make your Security Fee payment online.

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Select your payment method

AS THE PARENT(S) OR LEGAL GUARDIAN OF THE ABOVE CHILD(REN), I/WE AUTHORIZE ANY ADULT ACTING ON BEHALF OF THE CHABAD HEBREW SCHOOL TO HOSPITALIZE OR SECURE TREATMENT FOR MY CHILD(REN), I/WE FURTHER AGREE TO PAY ALL CHARGES FOR THAT CARE AND/OR TREATMENT. IT IS UNDERSTOOD THAT IF TIME AND CIRCUMSTANCES REASONABLY PERMIT, THE CHABAD HEBREW SCHOOL PERSONNEL WILL TRY, BUT ARE NOT REQUIRED, TO COMMUNICATE WITH ME PRIOR TO SUCH TREATMENT. I/WE HEREBY GIVE PERMISSION FOR MY CHILD(REN) TO PARTICIPATE IN ALL SCHOOL ACTIVITIES, JOIN IN CLASS AND SCHOOL TRIPS ON AND BEYOND SCHOOL PROPERTIES AND ALLOW MY CHILD(REN) TO BE PHOTOGRAPHED WHILE PARTICIPATING IN CHABAD HEBREW SCHOOL ACTIVITIES AND THAT THESE PICTURES MAY BE USED FOR MARKETING PURPOSES.