Registration 2021-22

Please fill out this form and submit it together with your tuition and registration fee.

Returning student registration - click here.

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

Full Name #1:

First NameLast Name

Cell Phone Number:

Area CodePhone Number

Full Name #2:

First NameLast Name

Cell Phone Number:

Area CodePhone Number

Registration type:*

In Person At Chabad

Tuition:*

1 Child: $7002 Children: $1,4003 Children: $2,100Other - Per my scholarship agreement with the Rabbi.

Other amount (if applicable):

$

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

Family Fee: $50

Registration Fee:*

Family Fee: $50

Total

$50.00

I would like to pay today: Full amount20% minimum: $0.00 $

20% minimum followed by 8 automatic payments.

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)

Authorized Persons To Pick Up Your Child: (other than parents/guardians)

Method of Payment:

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