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New Student Registration Form

New Student Registration Form

registration form.png

Hebrew School 2016 - 2017!

We are pleased to welcome you to our Hebrew School! Please fill out the form below carefully. When you press submit, this form will be sent to our administration office.

Register Online

Please fill out the form below:

Student 1* Student 2 Student 3
Student's Full Name* Student's Full Name
Student's Full Name
Hebrew Name*
Hebrew Name
Hebrew Name
Date of Birth*
Date of Birth
Date of Birth
School Attending*
School Attending
School Attending
Entering Grade
Entering Grade
Entering Grade
General Information*
Any Previous Jewish/Hebrew Lessons?*
How did you hear about Chabad Hebrew School?*
What goals would you like to see your child/ren accomplish in Hebrew School?*
Briefly describe your child/ren's personality*

Child/ren's favorite activities*

Sunday Class: $1,000/Child
Thursday Class: $1,000/Child
Private Tutoring: $65/at Home $50/at Chabad

DISCOUNTS: Sibling Discount: 10%

Parents' Information
Parents' Status* Married Widowed Divorced Separated
Home Phone*
Home Address*
Father's Full Name*
Work Phone*
Cell Phone*
Mother's Full Name*
Work Phone*
Cell Phone*
Emergency Contact Information*
Contact 1*
Relationship to child*
Contact 2*
Relationship to child*
Family Physician*
Are there any medical concerns that your child's teacher should be aware of?*
List all persons authorized to pick-up camper from campus.*

All of the forms must be on file in the Chabad office prior to the first day of Hebrew School. Parents are responsible for keeping the center informed of any changes in the emergency information.

If your child becomes ill during Hebrew School, you or your emergency contact will be called to take your child home. We will not release your child to anyone other than the parents unless we have authorization in writing in the Chabad office. If someone else will be picking up your child, please fill out the permission slip provided by the teachers.

In case of an accident or any emergency requiring immediate attention, our first attempt will be to reach the parent, then follow the instructions on the emergency form. We will call the doctor and/or paramedics. Our staff will take every precaution necessary to provide and implement a SAFE environment for your children.

In case of a disaster (i.e.: earthquake, fire etc.) that renders our facility unsafe, we would evacuate to the inner gate on the corner of Los Liones and Sunset Blvd. Also our staff will be assisting you with more detailed information upon your arrival so that you can pick your child up safely.

I certify that no information concerning the health of this Student has been withheld or misrepresented. I authorize our physician to provide further medical history should it be deemed necessary.

I hereby give permission, for my child registered in any of the Hebrew School programs of Chabad, to be taken by school bus on all outings and trips. I give permission to Chabad Hebrew Schooll to use photos of my children in any Hebrew School publicity.

Parent/Guardian* Date*

Payment Details
50% due on the first day of Hebrew School, 50% due by January 8, 2017 If you would like to pay in the office please select check by payment type
Last Name   Total charge amount
First Name   Payment Type
Address   Card Number
City   Exp. Date
State   CVV code 3 digits on back of card
Zip   Comments

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