Registration Form

Chabad Hebrew School 2024-2025 Registration Form
Returning Students click here
Child Full Name*

First Name Last Name
Child Full Jewish Name*

First Name Last Name
Date of Birth*

Month Day Year
School*
Previous Jewish Education, if any.
Current Grade* School year 2024-2025
Hebrew reading proficiency*

NoneSomewhatWell
Physician's name*
Physician's Phone Number*
Does your child have a medical condition or allergy, we should be aware of?*

YesNo
If yes, please describe it/them, & indicate what, if any, special precautions or care are needed.
Additional notable Information.
Are you registering another child?*

YesNo
Parent Information

Address*

Father's Name*

First Name Last Name
Father's Cell Phone*
Father's E-mail*
Father was*

Born JewishNot JewishConverted
Father's Hebrew Name If unknown or doesn't have one, please let us know.
Mother's Name*

First Name Last Name
Mother's Cell Phone*
Mother's E-mail*
Mother was*

Born JewishNot JewishConverted
Mother's Hebrew Name If unknown or doesn't have one, please let us know.
Parents are*

MarriedSeparatedDivorced
Were there any conversions or adoptions in the family?*

YesNo
If yes, please explain.
Payment
Tuition is $600 per child for the year. There is a non-refundable registration fee of $100 per child. This will be applied toward tuition payment.
Tuition & deposits are non refundable.*

Plan A: Payment in FullPlan B: Payment Plan (Please note, the non-refundable registration fee of $100 per child will be charged now. This will be applied toward payment plan. All tuition obligations must be paid in full by January 1, 2025)
Total

$0.00

Payment

Credit Card

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

Billing Address

Street Address

City

State / Province

Postal / Zip Code

Country

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Educate Your Child... Educate a Generation

Chabad Hebrew School 2024-2025 Registration Form