Returning Student Registration

Hebrew School Year 2022-2023
Returning Student Registration
Students Information*

First Name Last Name Hebrew Name
Birth Date*

Month Day Year
Number of Students Registering*
2nd Student

First Name Last Name Hebrew Name
2nd Student DOB

Month Day Year
3rd Student

First Name Last Name Hebrew Name
3rd Student DOB

Month Day Year
4th Student

First Name Last Name Hebrew Name
4th Student DOB

Month Day Year
5th Student

First Name Last Name Hebrew Name
5th Student DOB

Month Day Year
Additional notable Information, all information will stay confidential

Does your child have any allergies, medical condition? If yes, please describe.
I hereby give permission*

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.
Emergency Contact 1*

Full Name Phone Number Relation
Emergency Contact 2

Full Name Phone Number Relation
Total Amount charged at time of registration.

$0.00
Tuition - Per Student This will not be charged till September 1. If you wish to change the date please email [email protected]

$700 - Full Tuition Payment Pan (8 Payments) Would like to apply for a scholarship
Special Discounts Check all that apply

$70 Second Sibling Discount. $70 Third Sibling Discount $100 Referral Discount. for every new family that registers

Payment*

Credit Card

Credit Card Type
Credit Card Number	Security Code
Name on Card
Expiration Month	Expiration Year

Billing Address

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Country

Should be Empty:

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Hebrew School Year 2022-2023

Returning Student Registration

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