Student Information (one student per form)
First Name
Last Name
Hebrew Name
Gender
Select
Male
Female
Date of Birth
Grade
Allergies
Note
Parent 1
Relation
Father
Mother
First Name
Last Name
Cell Phone
Email
Parent 2
Relation
Mother
Father
First Name
Last Name
Cell Phone
Email
Family Information
Address
City
State
Zip
Home Phone
Marital Status
Select
Married
Divorced
Single
Widowed
Have there been any adoptions or conversions in the family?
Select *
No
Yes
If yes, please explain
Emergency Information
Name
Phone
Relation
Enrollment Options / Tuition & Fees
Please check which payment schedule you prefer
Onetime payment of $775 (registration prior to Aug 1, afterwards: $850)
6 monthly payments of $130 starting Sept 1. (registration prior to Aug 1, afterwards: $142/month)
Other Options
Optional: Hebrew School Family Shabbat Dinner ($50 per family)
I'd like to help by covering the processing fee of 3% for the tuition fees.
Tuition fees will be charged prior to the start of Hebrew school. If you chose the monthly option above, 6 monthly payments will be charged to your card starting on Sept 1. A registration / book fee of $100 will be charged upon submitting this form. This is in addition to the tuition.
Payment Information
Registration Fee
$100 - Registration / Book Fee
Card Type
Visa
MC
Amex
Discover
Number
Expiration
Code
Use contact info above
Name
Address
Zip
As the parent(s) or legal guardian of the above child, I/we authorize any adult acting on behalf of Chabad Hebrew School to hospitalize or secure treatment for my/our child, I/we 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/us prior to such treatment. It is also understood that Chabad Hebrew School can take photos and videos of your child and display them on the camp website and otherwise publicize them.
I agree to the terms and conditions above
-click here to agree-
Yes, I agree.
Submit
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