Registration - Chabad of Flagstaff

Does your child read basic Hebrew? Yes No
If yes: Well Fair Poor
Does your child have any difficulties with his/her general studies? Yes No
If yes, please explain:

Parent Information
Parent information is the same as last year. Skip section.
Mother's Name	Email
Home Phone	Cell Phone
Father's Name	Email
Home Phone	Cell Phone

Emergency Information
Emergency information is the same as last year. Skip section.
Emergency Contact (other than parent)	Relationship to Child
Home Phone	Cell Phone
Physician or medical facility	Physician's phone
Physician's Address	Allergies (please list)
Medical Conditions (If any, please explain)

Tuition Information
$529, includes registration, book fee and all supplies. (No child will be turned away due to lack of funds) Deposit: A $50 non-refundable deposit is due at time of registration, per child (to be deducted from tuition). Discounts: 10% discount for each additional child of the same family. 10% additional discount off your total tuition for each child of another family you successfully introduce to the Hebrew School of the Arts.
Please choose from the following 3 payment methods:
	PLAN A:	Pay the entire amount in full.
	PLAN B:	Pay the annual tuition on a monthly basis by submitting 10 post-dated checks of $47.90 each ($50 registration fee is due with this form), dated September through June. All checks must please be submitted before the first day of Hebrew School.
	PLAN C:	You may use your credit card to pay the tuition on a monthly basis. Your credit card will be billed $47.90 ($50 registration fee is due with this form) monthly from September through June. To do so, please include your credit card number and expiration date at the bottom of this page. .