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Returning Student Registration Form

Returning Student Registration Form

registration form.png

Hebrew School 2016 - 2017!

We are so excited to welcome you back to our Hebrew School this year! 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
School Attending*
School Attending
School Attending
Entering Grade*
Entering Grade
Entering Grade
General Information*
What goals would you like to see your child/ren accomplish in Hebrew School?*
Briefly describe your child/ren's personality*

Fees*

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

DISCOUNTS: Sibling Discount: 10%

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

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 Schoool, 50% due by January 8, 2017
Last Name Total charge amount
First Name Card Type
Address Card Number
City Exp. Date
State CVV code 3 digits on back of card
Zip Comments

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