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Student Information
 
Last Name
First Name
Hebrew Name
Age
DOB             
School
Grade Entering
Hebrew Reading Proficiency None    Somewhat    Well
Previous Jewish Education Yes            No
Where?
Any consideration, such as learning disorder or difficulty the school should be aware of (confidential)   


 

Parent Information
 
Address
City/Zip
Phone
Father's Name
Father's Occupation
Father Jewish Yes           No
Father's Cell
Father's Email
Mother's Name
Mother's Occupation
Mother Jewish Yes           No
Mother's Cell
Mother's Email
Would you be willing to help with school activities? Yes            No 
Does either parent have any special resources or skills to offer our children or teachers?  


 

Emergency Information
 
Emergency Contact 1
Phone
Emergency Contact 2
Phone
Doctor's Name
Doctor's Phone Number
Doctor's Hospital Affiliation  
Medical Insurance Company
Policy 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. 



 

 

 
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/plans must be submitted to the school office before any child will be permitted to attend classes. 
Tuition for the year, per child: $1250 
Registration Fee:  $50
Discount: There is a 5% discount off of the regular tuition for each additional child of the same family. There is a 10% additional discount off your total tuition for each child of another family you successfully introduce to the Chabad Hebrew School.
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.
PLAN B: You may pay the annual tuition on a monthly basis by submitting 5 checks of $250.00 each dated September through Jan. All checks must be submitted before the first day of Hebrew School.
PLAN C: You may use your credit card to pay the tuition on a monthly basis.  Your credit card will be billed $125.00 monthly September - June. To do so please include your credit card number and expiration date.

Please note: Chabad Hebrew school will not turn anyone away due to a lack of funds for tuition assistants please contact us (confidentially)

 
 Method of payment:
Credit Card
Check in the mail
Credit Card Information
Credit Card Number   Billing Address  
City   State, Zip  
Charge Amount   Exp Date  
CVV      

 

  As the he 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:  Date: 

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

 

 

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