We are currently accepting application forms for the 2018-2019 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.

If you would prefer to fill out this paper and mail it into our office, a PDF can be found here.

Please note that one registration form per child is needed.

We look forward to a wonderful year of learning and growth.

Student Profile Studen
CHILD #1
Last Name 
First Name 
Hebrew Name 
Gender 
 Male  Female
Date of Birth 
School 
Grade 
Previous Jewish education? 
 Yes  No
If Yes please describe 
Hebrew Reading Proficiency:   None   Somewhat   Well
CHILD #2
Last Name 
First Name 
Hebrew Name 
Gender 
 Male  Female
Date of Birth 
School 
Grade 
Previous Jewish education? 
 Yes  No
If Yes please describe 
Hebrew Reading Proficiency:   None   Somewhat   Well
CHILD #3
Last Name
First Name
Hebrew Name
Gender
Male Female
Date of Birth
School
Grade
Previous Jewish education?
Yes No
If Yes please describe
Hebrew Reading Proficiency: None Somewhat Well
Have there been any conversions or adoptions in the family? Yes No
If yes please explain
Parent Information

Father

Title/First Name
Last Name
Work Phone
Cell Phone
Occupation
Email
Mother
Title/First Name
Last Name
Work Phone
Cell Phone
Occupation
Email
Parents
Address
City/State/ Zip
Home Phone
Address 
City/State/ Zip 
Home Phone 
Emergency Information
Emergency 1
Name
Phone #
Relation
Emergency 2
Name
Phone #
Relation
Family Physician    
Doctor's Name
Doctor's Address
Doctor's Phone #
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.

Tuition Fees
Grades K-7: Sunday, 9:30 am - 12:00 pm
$800 annual tuition, $50 Registration & book fee
I would like to pay a one time installment of $850 per Child
I would like to pay in eight installments of $106.25 per child
Payment Information
Card Number
Name on Card
Expiration Date
Security Code
What's This?
Billing Address
Billing Zip
Disclaimer
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:
We look forward to a wonderful year of learning and growth!