New Student Online Registration

Child 1 Full Name:*

First NameLast Name

Child 1 Hebrew Name:*

Child 1 Preferred Name:

Child 1 Birth Date:*

MonthDayYear

Child 1 Current Grade:

Child 1 Hebrew Birth Date:

Child 2 Full Name:

First NameLast Name

Child 2 Hebrew Name:

Child 2 Preferred Name:

Child 2 Birth Date:

MonthDayYear

Child 2 Current Grade:

Child 2 Hebrew Birth Date:

Child 3 Full Name:

First NameLast Name

Child 3 Hebrew Name:

Child 3 Preferred Name:

Child 3 Birth Date:

MonthDayYear

Child 3 Current Grade:

Child 3 Hebrew Birth Date:

Home Phone Number

Area CodePhone Number

Address*

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

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?

Father's Full Name*

First NameLast Name

Father's Hebrew Name:

Cell Phone Number

Area CodePhone Number

E-mail Address:

Occupation:

Company Name:

Mother's Name:*

First NameLast Name

Mother's Hebrew Name:

Cell Phone Number:*

Area CodePhone Number

E-mail Address:

Occupation:

Company Name:

Full Name:*

First NameLast Name

Relationship to Child:*

Cell Phone Number:*

Area CodePhone Number

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.

Tuition:*

1 Child: $7502 Children: $1,5003 Children: $2,250Other - Per scholarship agreement with the Rabbi.

Other amount (if applicable):

$

Registration Fee: (Waived if submitted before June 1, 2022)*

Family Fee: $50

Late Fee:$50 late fee for registering after Aug 24th will be added.

Late Fee: $50

Total

$0.00

Registration is only complete when payment has been paid in full or 10 monthly payments have been scheduled starting July 1, 2022.

Payment Option:*

Pay in fullPay in 10 monthly payments (provide card information below).

Payment:

Credit Card Check

Postal / Zip Code

Country

Abbott & Carole Cohen Hebrew School

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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