New Student Online Registration

Children's Information:
Child 1:
Child 1 Full Name:*
First Name Last Name
Child 1 Hebrew Name:*
Child 1 Preferred Name:
Child 1 Birth Date:*

Month Day Year
Child 1 Current Grade:
Child 1 Hebrew Birth Date:
Child 2:
Child 2 Full Name:
First Name Last Name
Child 2 Hebrew Name:
Child 2 Preferred Name:
Child 2 Birth Date:

Month Day Year
Child 2 Current Grade:
Child 2 Hebrew Birth Date:
Child 3:
Child 3 Full Name:
First Name Last Name
Child 3 Hebrew Name:
Child 3 Preferred Name:
Child 3 Birth Date:

Month Day Year
Child 3 Current Grade:
Child 3 Hebrew Birth Date:
Home Phone Number

Area Code Phone Number

Address*

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

Religious & Educational History:
Do your children read basic Hebrew?*

NoneSomewhatWell
Do your children have any difficulty with general studies?
Are there any adoptions in your family (children, parents or grandparents)?
Have you or your spouse, parents, grandparents or children ever converted to Judaism?
Contact Information:
Father's Full Name*
First Name Last Name
Father's Hebrew Name:
Cell Phone Number

Area Code Phone Number
E-mail Address:
Occupation:
Company Name:
Mother's Name:*
First Name Last Name
Mother's Hebrew Name:
Cell Phone Number:*

Area Code Phone Number
E-mail Address:
Occupation:
Company Name:
Emergency Contact Person: (other than parent/guardian)
Full Name:*
First Name Last Name
Relationship to Child:*
Cell Phone Number:*

Area Code Phone Number
Medical & Activity Release Form
I hereby permit my child(ren) to participate in all school activities, and to join in all class and school trips, on or beyond school properties, and on any transportation selected by the Chabad Hebrew School.I hereby give consent to the administration of the Chabad Hebrew School to take whatever medical measures they deem necessary, at my expense, for my child in the event of a medical emergency.
Method of Payment:
Tuition: $800 | Registration Fee: $50 Per Family | Payment plans available. | If you are in need of a scholarship please contact Rabbi Denburg at 954.501.8920.
Tuition:*

1 Child: $8002 Children: $1,6003 Children: $2,400Other - Per scholarship agreement with the Rabbi.
Other amount (if applicable):

$
Registration Fee:* Waived until June 7, 2024

Family Fee: $50
Late Fee:* $50 late fee for registering after Aug 23rd will be added.

Late Fee: $50
Payment Option:*

Pay in fullPay in 8 monthly payments beginning September 1, 2024 (provide card information below).
Total

$0.00
Registration is only complete when payment has been paid in full or 8 monthly payments have been scheduled starting September 1, 2024.

Please note the registration fee will be charged to your credit card upon submitting your registration form.

Payment:

Credit Card Check

Postal / Zip Code

Country

Should be Empty:

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Children's Information:

Religious & Educational History:

Contact Information:

Emergency Contact Person: (other than parent/guardian)

Medical & Activity Release Form

Method of Payment:

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