Registration Form

Chabad Hebrew School 2026-2027 Registration Form
Child Full Name*
First Name Last Name
Child Full Jewish Name* First Name, Middle Name
Date of Birth*

Month Day Year
School*
Previous Jewish Education, if any.
Current Grade* School year 2026-2027
Hebrew reading proficiency*

NoneSomewhatWell
Physician's name*
Physician's Phone Number*
Does your child have a medical condition or allergy, we should be aware of?*

YesNo
If yes, please describe it/them, & indicate what, if any, special precautions or care are needed.
Additional notable Information.
Parent Information

Address*

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Father's Name*
First Name Last Name
Father's Cell Phone*
Father's E-mail
Father was*

Born JewishNot JewishConverted
Father's Hebrew Name If unknown or doesn't have one, please let us know.
Mother's Name*
First Name Last Name
Mother's Cell Phone*
Mother's Email*
Mother was*

Born JewishNot JewishConverted
Mother's Hebrew Name If unknown or doesn't have one, please let us know.
Parents are*

MarriedSeparatedDivorced
Emergency Information
Emergency Contact*
First Name Last Name
Phone Number*
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 and allow my child to be photographed while participating in Chabad Hebrew School activities.
*

I accept
Payment
Tuition is $650 per child for the year. There is a non-refundable registration fee of $100 per child. This will be applied toward tuition payment.

Discounts
Siblings: 10% off regular tuition for each additional child.
Referral: There is an additional $50 discount off your child's tuition for each new family successfully introduced to Chabad Hebrew School.
Tuition & deposits are non refundable.*

Plan A: Payment in FullPlan B: Payment Plan of $100/month starting in September. (Please note, the non-refundable registration fee of $100 per child will be charged now. This will be applied toward payment plan. All tuition obligations must be paid in full by March 1, 2027)
Total

$0.00

Payment*

Credit Card

We accept Visa, MasterCard, American Express, Discover
Credit Card Number	Security Code
Name on Card
Expiration Month	Expiration Year

Billing Address

Street Address

City

State / Province

Postal / Zip Code

Country

Signature* My e-signature will be legally binding as a printed signature.
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Educate Your Child... Educate a Generation

Chabad Hebrew School 2026-2027 Registration Form

Parent Information

Emergency Information

Payment