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Youth & Teens Hebrew School Register Online!

Registration

PARENT INFO
Mother's Name:*
First Name Last Name
Mother's Hebrew Name:*
Mother's Occupation:*
Mother's Home Phone Number:*

Area Code Phone Number
Mother's Cell Phone Number:*

Area Code Phone Number
Mother's E-mail Address:*
Father's Name:*
First Name Last Name
Father's Hebrew Name:*
Father's Occupation:*
Father's Home Phone Number:*

Area Code Phone Number
Father's Cell Phone Number:*

Area Code Phone Number
Father's E-mail Address:*
Synagogue/s affiliated with:*

I am affiliatedI am unaffiliated
Synagogue/s affiliated with:
Which parent of the child is Jewish?*

MotherFatherBoth
Were there any conversions or adoptions in your family? *

YesNo
If yes, please describe:
I was referred to Chabad’s Hebrew School By: *
STUDENT INFORMATION
Number of Children being registered:* $50 per child
Child 1
Child's Name:*
First Name Last Name
Hebrew Name:*
Date of Birth:*

Month Day Year
Age:*
Grade:* Entering in August
Name of School:*

Address*

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

What would you like your child to gain by joining Chabad's Hebrew School of the Arts?*
Please upload a current picture of your child here: *
Child 2
Child's Name:*
First Name Last Name
Hebrew Name:*
Date of Birth:*

Month Day Year
Age:*
Grade:* Entering in August
Name of School:*
What would you like your child to gain by joining Chabad's Hebrew School of the Arts?*
Please upload a current picture of your child here: *
Child 3
Child's Name:*
First Name Last Name
Hebrew Name:*
Date of Birth:*

Month Day Year
Age:*
Grade:* Entering in August
Name of School:*
What would you like your child to gain by joining Chabad's Hebrew School of the Arts?*
Please upload a current picture of your child here: *
MEDICAL/EMERGENCY INFORMATION
Is there any special medical information regarding your child/children which our school should be aware of?*
Emergency Contact 1: Name:*
First Name Last Name
Emergency Contact 1: Phone Number:*

Area Code Phone Number
Emergency Contact 1: Relationship:*
Allergies (if any please list)*

YesNo
If yes please explain:
FAMILY PHYSICIAN
Doctor's Name:*
First Name Last Name
Doctor's Phone Number:*

Area Code Phone Number

Doctor's Address:*

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

As the parent(s) or legal guardian(s) of child/ren noted above, I/we authorize any adult acting on behalf of the Chabad’s Hebrew School of the Arts to hospitalize or secure treatment for my child. I further agree to pay for all charges for that care and/or treatment. It is understood that, if time and circumstances reasonably permit, the School will try to communicate with me prior to such treatment.I/we hereby give permission for my child/ren to attend all field trips and outings sponsored by Chabad’s Hebrew School of the Arts, and allow my child to be photographed while participating in school’s activities.*
Parent Signature Date
PROGRAM OPTIONS
Option 1: Zoom Hebrew Classes - Mondays or Tuesdays, $1,000
a 1/2 hour between 4:00 PM and 6:00 PM, Hebrew Language One-on-One Classes
$100 book, supplies, and security per child

Option 2: Main Hebrew School Program, In-Person - Wednesdays, $1,000
2 hours Judaics + Hebrew Group Classes, 4:00 PM - 6:00 PM, September - May
$200 book, supplies, and security per child

Please note: There are no scholarships for private tutoring - Zoom Hebrew Language. Book/supply/security fee needs to be paid in full at the start of the year.
Child 1 will be attending:*

Virtual Hebrew Language ProgramMain Hebrew School ProgramBoth Programs
Child 2 will be attending:*

Virtual Hebrew Language ProgramMain Hebrew School ProgramBoth Programs
Child 3 will be attending:*

Virtual Hebrew Language ProgramMain Hebrew School ProgramBoth Programs
CHS - SUNDAY MORNING, 10:00 AM - 12:00 PM

Full Year: Primary Program, Preschool - 8th Grade = $875 + $100 Book/Supplies Fee
Additional Opportunities Available For Your Children!
Cost: $60/hour session, and $40/half-hour session. Must be purchased in increments of 8 sessions.
"One-on-one" Judaics enrichment sessions in the Judaics subject your child is learning"Make-up" sessions for children who were absent from Sunday School or Hebrew SchoolHomework assistance in both Hebrew and JudaicsBat/Bar Mitzvah program and lessons customized to meet the needs of your child
Total # of half hour sessions, and total amount to be added to my CHS tuition: $40/half hour
Total # of hourly sessions, and total amount to be added to my CHS tuition: $60/hour
Days of the week that are best for my child to come in (first come, first serve basis):
Final Fees/Requirements:

Registration Fee $100
Discounts Applicable:

5% Discount for each additional child of the same family attending Chabad Hebrew School
PAYMENT
Tuition Payment Plans:*

Please charge my credit card in fullI would like to pay 50% now, and 50% by January 1I would like to pay over ten months.
Need Tuition Assistance
No one will be turned away for lack of funds.
If you are unable to pay the full amount, please write below what you can pay.
All tuition remains confidential.
This is how much I can pay per child, weekly:
Please note:
*Payment Plans C: you will be charged on the 15th of the month, beginning August 15th through May 15th.
*Book and supplies fee is charged in August.
Total;

$0.00

Payment*

Credit Card Check or Payment Plan as stated above

Postal / Zip Code

Country

QUESTIONS? COMMENTS!
Initial here for signature of parent or legal guardian *
This is how I can contribute to the school - please list any talents or skills you are available to share, here:
Should be Empty:

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