Student Information
Last Name
First Name
Hebrew Name
Grade Entering
Hebrew Reading Proficiency None Somewhat Well
Previous Jewish Education Yes No
Any consideration, such as learning disorder or difficulty the school should be aware of (confidential)
Parent Information
Father's Name
Father's Occupation
Father's Cell
Father's Email
Mother's Name
Mother's Occupation
Mother born Jewish? Converted by whom?
Mother's Cell
Mother's Email
Emergency Information
Emergency Contact 1
Emergency Contact 2
Doctor's Name
Doctor's Phone Number
Medical Insurance Company
Policy Number

CONFIDENTIAL: Does your child have any allergies or other medical condition we should be aware of? If yes, please describe them and indicate special precautions or care needed.

Tuition Agreement
The following is a tuition agreement for the Chabad Hebrew School. The agreement explains the tuition fees, payments plans and refund policies. Please read it through carefully. Full payment or payment plans must be submitted to the school office before any child will be permitted to attend classes.
Tuition for the year per child: $800
Book Fee: $50


Sibling Discount : First child is a full tuition. Each additional child is a 5% discount off total tuition.

Refer a friend Discount There is a 25% discount off your total tuition for each family you successfully introduce to the Chabad Hebrew School.

Please indicate name of family that you have successfully referred to Hebrew School 18-19

All payments/arrangements shall be arranged by the first day of Hebrew school
You may pay the entire amount in full with a check, cash or credit card.

Please note: Chabad Hebrew school will not turn anyone away due to a lack of funds for tuition assistants please contact us for payment/plan 

A $50 registration fee is required to complete registration
Method of payment:
Credit Card / Master Card /Visa/ Amex
Credit Card Information
Credit Card Number Billing Address
City State, Zip
Charge Amount Exp Date


As the he parent(s) or legal guardian of the above child, I/we authorize any adult acting on behalf of Chabad Hebrew School 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, Chabad Hebrew School personnel 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 school activities, join in class and school trips on and beyond school properties and allow my child to be photographed while participating in Chabad Hebrew School activities and that these pictures may be used for marketing purposes.

I Accept

Name: Initials: Date:

We look forward to a wonderful year of learning and growth!