REGISTER

BH

We are currently accepting applications for the 2024-2025 school year.

Please fill out ALL fields of this form.

If you have any questions or concerns you'd like to discuss, feel free to contact us.

We are available to answer any questions and to show you the curriculum

Please note that one registration form per child is needed.

Please email a Health form per child.

Once the completed form is received, please allow up to 7 business days to receive a reply and/or acceptance letter.

We look forward to a wonderful year of learning and growth.
Child would like to attend:

Older DivisionYounger Divistion
Younger Division: Grades K-2: Sundays 10am - 12pm
Older Division:Grades 3-7: Sundays 10am - 12pm
STUDENT INFORMATION
Full Name*
First Name Last Name
Hebrew Name*
If you're not sure, write "not sure"
Birth Date*

Month Day Year
School attending*
Grade entering* September 2024
Previous Jewish Education*
If any
Hebrew reading proficiency*

NoneSomewhatWell

Address*

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

Does your child have a medical condition or allergy, we should be aware of? (CONFIDENTIAL):*

YesNo
If yes, please describe it/them, & indicate what, if any, special precautions or care are needed. (CONFIDENTIAL)
Only personnel that are required to know will be notified
Additional notable Information
PARENT INFORMATION
Home Phone Number

Area Code Phone Number
Mother
Full Name*
First Name Last Name
Cell phone Number*

Area Code Phone Number
E-mail*
Hebrew Name*
If unknown or doesn't have one, please let us know.
Occupation
Father
Full Name*
First Name Last Name
Hebrew Name If father has one
Cell phone Number

Area Code Phone Number
E-mail*
Occupation
Important Information
Parents are:*

MarriedDivorcedSeperatedIt's complicated!
Were both parents born to Jewish parents?*

YesNo
If not, please explain:
Were there any conversions or adoptions in the family?*

YesNo
If yes, please explain:
As the parent(s) or legal guardian of the above child, I/we authorize any adult acting on behalf of Chabad Jewish Center to hospitalize or secure treatment for my child, I further agree to pay all charges for that care and/or treatment. It is understood that if time and circumstances reasonably permit, we will try, but are not required, to communicate with me prior to such treatment. I hereby give permission for my child to participate in all Chabad Hebrew School activities, join in class trips and allow my child to be photographed while participating in Chabad Hebrew School and that these pictures may be used for marketing purposes.
Agree to Authorization*

I Agree
By typing my initials here, I consent to all of the above:*
Write your initials in this box.
PAYMENT
* The registration fee must be paid in order to process this application.
(If your child isn't accepted, your registration fee will be refunded.)
* The remainder of tuition can be paid now (below) or no later than July 30.
* The "events fee" is only required once per family (even is you're registering more than one child.)
_______________________
* We're aware that some people are having financial difficulties. At Chabad we have the real "NO CHILD WILL BE LEFT BEHIND" program. Partial scholarships may be available for parents who can't afford the full tuition cost. Please reach out to us so we can help you.
Registration Fee New Student: $50 . . . Returning Student: $25 . Paying in full TODAY: $10. (Only if paying in full by CC!)

$50$25$750
Book & Supplies Fee: All Students

$35
Total

$750.00

Pay by:*

Credit Card Paypal Check or Payment Plan

Postal / Zip Code

Country

I would like to receive news and updates by email
Should be Empty:

This page uses TLS encryption to keep your data secure.

Educate Your Child... Educate a Generation

STUDENT INFORMATION

PARENT INFORMATION

Mother

Father

Important Information

PAYMENT