Returning Student Registration

Hebrew School Payment
RATES:
Kindergarten - FREE Tuition (Only pay $180 Supplies Fee)
Grades 1-6 - $1800/Full Cost, $1100/Subsidized Tuition
BM Prep Class, Grades 6-7 - $1000
Parents Name:*

First Name Last Name
Family Information:
Is the family contact information (address, phone numbers, emails) we have on record still current?*

YesNo

Address

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

Home Phone Number
Father's Name:

First Name Last Name
Father's Hebrew Name:

First Name Last Name
Father's Work Phone:
Father's Cell Phone Number:
Father's Occupation:
Mother's Name:

First Name Last Name
Mother's Hebrew Name:

First Name Last Name
Mother's Work Phone Number
Mother's Cell Phone Number
Mother's Occupation:
Mother's E-mail
Father's E-mail
Which email would you like used for updates and newsletters?

Mother'sFather'sBoth
Marital Status:

MarriedSingleDivorced
Child #1
Child #1 Name:*

First Name Last Name
Childs Age:*
Current School Attending:*
Child #1 Grade*
Payment Child #1
Kindergarten*
Grades 1-6*
BM Prep Class - Grades 6 & 7*
Financial Assistance needed. I can afford to pay:
Child #2
Child #2 Name:

First Name Last Name
Childs Age:
Current School Attending:
Child #2 Grade
Payment Child #2
Kindergarten*
Grades 1-6*
BM Prep Class - Grades 6 & 7*
Financial Assistance needed: I can afford to pay:
Child #3
Child #3 Name:

First Name Last Name
Childs Age:
Current School Attending:
Child #3 Grade
Payment Child #3
Kindergarten*
Grades 1-6*
BM Prep Class - Grades 6 & 7*
Financial Assistance needed: I can afford to pay:
Medical Information:
Medical Release:*

I hereby give consent to the administration of the Chabad Hebrew School to take whatever medical measures they deem necessary, at my expense, for my child in the event of a medical emergency. I hereby give permission to my child to participate in all school outings and field trips beyond school properties and to use any transportation selected by the Chabad Hebrew School. I grant permission for my child to be photographed in individual or group pictures which may be used by Chabad Hebrew School for P.R.
Permission Slip:
*

I hereby give permission to my child to participate in all school outings and field trips beyond school properties and to use any transportation selected by the Chabad Hebrew School. I also grant permission for my child to be photographed in individual or group pictures which may be used by Chabad Hebrew School for P.R.
Total

$0.00

Credit Card

We accept Visa, MasterCard, American Express, Discover
Credit Card Number	Security Code
Name on Card
Expiration Month	Expiration Year

Should be Empty:

This page uses TLS encryption to keep your data secure.

Hebrew School Payment

Family Information:

Child #1

Payment Child #1

Child #2

Payment Child #2

Child #3

Payment Child #3

Medical Information:

Permission Slip:

More in this section