Hebrew School Registration

Registration is now open for Chabad Hebrew School of the Arts 2016/17. 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.

Student Information
(To register more than one child, simply fill out the student & emergency information a second time after submitting the completed form once.)

Last Name..............................First Name ..........................Hebrew/Jewish Name
....

Date of Birth........................Age
.. Male Female

Home Address .....................................City ............................ State .........Zip
.....
Name of School.............................................................Grade 2015/16
..

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

Mother's Name....................................Home Phone..........................Work Phone
.. ..
Cell Phone..........................................Email
..

Father's Name ...................................Home Phone..........................Work Phone
....
Cell Phone.........................................Email
..

Family Information

Were there any conversions or adoptions in your family? Please Select No Yes
If yes, please explain:

Emergency Information

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)

Permission for Emergency Medical Treatment:
As the parent(s) or legal guardian(s) of the above child, I/we authorize any adult acting on behalf of Chabad Jewish Community Center Hebrew School to hospitalize or secure treatment for my child. I further agree to pay all charges for that care and/or treatment. It is understood that, if time and circumstances reasonably permit, Chabad Jewish Community Center Hebrew School will try to communicate with me prior to such treatment.

Accept Do Not Accept
Initial here:

Tuition Payment:

$450, includes registration, book fee and all supplies.
(No child will be turned away due to lack of funds).

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 $40 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 $40 ($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.

Please include with this form (via credit card or check) a $50 payment (towards tuition) to secure a space for your child.