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Student Information

Male Female

Does you child read basic Hebrew?
None Somewhat Well

Does your child speak/understand Hebrew?
None Somewhat Well

Does your child have previous Jewish Education Yes No
If yes, please describe:

What school does your child attend?
Grade entering:

Child 2

Male Female

Does you child read basic Hebrew?
None Somewhat Well

Does your child speak/understand Hebrew? None Somewhat Well

Does your child have previous Jewish Education Yes No
If yes, please describe:

What school does your child attend?
Grade entering:


Child 3

Male Female

Does you child read basic Hebrew?
None Somewhat Well

Does your child speak/understand Hebrew? None Somewhat Well

Does your child have previous Jewish Education Yes No
If yes, please describe:

What school does your child attend?
Grade entering:


Synagogue affiliated with:
Is the natural mother of the child born Jewish?
Were there any conversions or adoptions in your family, including grandparents?

If yes, please describe:

Any considerations, such as learning disorder or difficulty, the school should be aware of?(Confidential):

 

Parent Information









 

Emergency Contact Information
Please list two contacts to be used in case of emergencies (other than your home and business numbers).










Please send a copy of your insurance card for our files.

Up to date with vaccinations? Yes No Date of last tetanus shot:

Please Include Allergies or other Medical Conditions:

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.
Accept Do Not Accept
Initial here:

 

Chabad Hebrew School Tuition Agreement

The following is a tuition agreement for the Chabad Hebrew School. The agreement explains the tuition fees, payments plans and refund policies. Please read it through carefully. If paying by check or cash, full payment must be submitted to the school office before any child will be permitted to attend classes.

The tuition for the Chabad Hebrew School is $60 per child per month. (September through May). Plus $75 Registration Fee per child, (5% extra charge for payment Via Credit Card - there will not be any other extra hidden fees through the year!).


You may choose from the following payment methods:
PLAN A: You may pay the entire amount in full with a check, cash or credit card. - Pre-Paid Discounted Rate $500 plus $75 registration fee - Total $575 (cannot be combined with other discounts - if paying with credit card total including 5% charge = $603.75)

PLAN B: You may pay the annual tuition on a monthly basis by submitting 9 checks of $60 each, dated September through May. All checks must be submitted before the first day of Hebrew School. (plus a one time $75 Registration Fee)

PLAN C: You may use your credit card to pay the tuition on a monthly basis. Your credit card will be billed $63 monthly September through May. To do so please include your credit card number and expiration date at the bottom of this page. (plus a one time $78.75 Registration Fee)

Discounts Available:
$20 off each Additional Sibling
$35 off for signing up a new Hebrew School Family
Registration Submitted & paid by July 15th discounted to $60

NO ONE will be turned away on account of funds, call us for scholarship assistance and discounted rates

Please note - checking this box and signing your name, constitutes a signed authorization. By signing below, you agree to make the necessary payments at the proper time. Refunds for children withdrawing from school before the end of the school year will be pro-rated up to February 1 provided that the school office is given 30 days written notice and does not include a $100.00 registration and book fee. Tuition refunds will not be granted to children withdrawing from school after February 1. There are no refunds or credits for days missed due to illness, holidays, or family vacations.
Accept Do Not Accept
Your FULL name here:

Payment Options:
VISA MasterCard Discover American Express Check in mail

Check or Card No.


Email for Receipt
I would like to help a child! CHS Scholarship Fund Donation Amount:
i would be able to assist CHS , please contact me

TOTAL AMOUNT TO CHARGE NOW
If Doing a Monthly Payment Plan, Only Charge Now Registration and any Additional Scholarship Donation

I heard about the Chabad Hebrew School from:
By Clicking Submit i am authorizing my card to be charged and confirming the truth of the application.

 

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