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New Student

New Student

Returning students - click here.
We are currently accepting application forms for the 2016-2017 school year. Please fill out all fields of this form. If you have any questions or concerns you'd like to discuss with us, please contact us.

We look forward to a wonderful year of learning and growth. First day of school is September 11th.

Tuition & Book Fee: $660

Student Profile
 
Name
Last
Hebrew Name
DOB Age
School
Grade Entering
Hebrew Reading Proficiency None Somewhat Well
Previous Jewish Education Yes No
Where?

Name of synagogue affiliated with

Parent Information
 
Address
City/Zip
Home Phone
Email Address
Father's Name
Father's Occupation
Father's Cell
Mother's Name
Mother's Occupation
Mother born Jewish? Converted by whom?
Mother's Cell
Emergency Information
 
Emergency Contact 1
Phone
Emergency Contact 2
Phone
Doctor's Name
Doctor's Phone Number

CONFIDENTIAL: Does your child have any allergies or other medical condition we should be aware of? If yes, please describe them and indicate special precautions or care needed.



As the parent(s) or legal guardian of the above child, I/we authorize any adult acting on behalf of Chabad 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 Hebrew School personnel will try, but are not required, to communicate with me prior to such treatment. I hereby give permission for my child to participate in all school activities, join in class and school trips on and beyond school properties and allow my child to be photographed while participating in Chabad Hebrew School activities and that these pictures may be used for marketing purposes.

I Accept

Name: Initials:

Pay Online

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Payment Options
UPDATE: Tuition needs to be paid in full by October 31st. No refunds. One free-day trial for new students.

$660 Tuition + Book fee
Check to be received before October 23 to avoid late enrollment fee of $75.
T-shirt size :

Card Number
Name
City
Zip
Card Type
Exp. Date Month Year
Referred by
Message to billing

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