New Student Online Registration

Parent Contact Information:
Father's Name*
First Name Last Name
Father's Hebrew Name:
Cell Phone Number*
E-mail Address:*
Mother's Name:*
First Name Last Name
Mother's Hebrew Name:
Cell Phone Number:*
E-mail Address:*

Address*

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

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 Food Allergies:
Register a second child?

YesNo
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 Food Allergies:
Register a third child?

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

NoneSomewhatWell
Does your child have any difficulty with general studies?
Are there any adoptions in your family (children, parents or grandparents)?
Are there any conversions in your family (children, parents or grandparents)?
Emergency Contact Person: (other than parent/guardian)
Full Name*
Relationship to Child:*
Cell Phone Number:*
Medical & Activity Release Form
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.
Tuition Payment:
Tuition: $800 | Security Fee: $100 Per Family | Registration Fee: $50 Per Family | Payment plans available.
To request a full or partial scholarship, please contact Rabbi Denburg at 954-501-8920.
Tuition:*

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

$
Security Fee:*

Family Fee: $100
Registration Fee:*

Family Fee: $50
Late Fee: $50 late fee for registering after Aug 19th will be added.

Late Fee: $50
Payment Option:*

Pay in fullPay in 8 monthly payments beginning September 1, 2026 (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, 2026.

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

Payment:

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Postal / Zip Code

Country

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Parent Contact Information:

Children's Information:

Religious & Educational History:

Emergency Contact Person: (other than parent/guardian)

Medical & Activity Release Form

Tuition Payment:

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