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Abbott & Carole Cohen Hebrew School

Educate your child... educate a generation!

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Returning Student Online Registration

Student Name #1:*

First Name Last Name
Hebrew Name:*
Date of Birth:*
School:*
Grade Entering:*
Student Name #2:

First Name Last Name
Hebrew Name:
Date of Birth:
School:
Grade Entering:
Student Name #3:

First Name Last Name
Hebrew Name:
Date of Birth:
School:
Grade Entering:
Is your phone number, address and email address the same as last year?*

Yes No

Address:

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

Phone Number:

Area Code Phone Number
E-mail
Is your emergency contact person the same as last year?*

Yes No
New Emergency Contact Name and Phone #:
Method of Payment:

Tuition: $750 | Registration Fee: $50 Per Family | Payment plans available. | If you are in need of a scholarship please contact Rabbi Denburg 954.501.8920
Tuition:*

1 Child: $750 2 Children: $1,500 3 Children: $2,250 Other - Per scholarship agreement with the Rabbi.
Other amount (if applicable):

$
Registration Fee:*

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 full Pay in 8 monthly payments (provide card information below).

Payment Form:

Credit Card Check

Postal / Zip Code

Country

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.
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