Registration

Registration is now open for Chabad Hebrew School of the Arts 2021/2022 . If your child is currently a student in the Chabad Hebrew School of the Arts, and you would like to re-register him/her, simply skip the parent, family & emergency sections unless anything has changed.

Child's Name*

First Name Last Name

Child's Date of Birth*

Grade 2021/2022*

Add second child*

Yes No

Second Child's Name

First Name Last Name

Second Child's Date of Birth

Second Child's Grade 2021/2022

Add third child

Yes No

Third Child's Name

First Name Last Name

Third Child's Date of Birth

Third Child's Grade 2021/2022

Is parent information the same as last year?*

Yes No

Mother's Name

First Name Last Name

Mother's Cell Phone

Area Code Phone Number

Mother's Email

Father's Name

First Name Last Name

Father's Cell Phone

Area Code Phone Number

Father's E-mail

Home Address

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

Jewish Genealogy*

Were there any conversions or adoptions in your family?*

Yes No

If yes, please explain

Is emergency information the same as last year?*

Yes No

Emergency Contact (other than parent)

First Name Last Name

Relationship to Child

Emergency Contact's Phone Number

Area Code Phone Number

Physician

Physician's Phone Number

Area Code Phone Number

Allergies (please list)

Medical Conditions (If any, please explain)

Emergency Medical Treatment Agreement*

Accept Do Not Accept

Intial Here*

$549 per child
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.

Tuition Payment Plans:
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 $55.44 each ($50 registration fee is due with this form), dated September through May. 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 $55.44 ($50 registration fee is due with this form) monthly from September through May. To do so, please include your credit card number and expiration date at the bottom of this page.

Payment Plan Selection*

Payment Plan A (Full Tuition) Payment Plan B (Monthly Check) Payment Plan C (Monthly Credit Card)

Deposit*

Total

$0.00

Payment*

Credit Card

Credit Card Type
Credit Card Number	Security Code
Expiration Month	Expiration Year

Student Information

Parent Information

Family Information

Emergency Information

Permission for Emergency Medical Treatment

Tuition Information