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Please fill out this form as an initial registration for the CJC Hebrew School. To register and pay via check please send to our office 4010 Park Street North • St. Petersburg, FL 33709-4034 |
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Student Information
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Male Female |
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Does your child have previous Jewish Education Yes No |
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If yes, please describe:
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What school does your child attend?
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Grade entering:
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Synagogue affiliated with:
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Is the natural mother of the child Jewish? |
Yes No
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Were there any conversions or adoptions in your family?
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Yes No
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If yes, please describe:
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Does your child read basic Hebrew?
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None Somewhat Well
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Does your chld have any difficulty with general studies?
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Parent Information |
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Emergency Contact Information
Please list two contacts to be used in case of emergencies (other than your home and business numbers). |
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Do Not Accept
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Method of Payment
Payment in Full | $475 Early Bird Pricing if paid in full by July 12 includes tuition, registration & book fee.
Payment in Full after July 12 | $525 includes tuition, registration & book fee.
Three-Payment Option ($175 three times a year)
I, do hereby state that I will pay 's Hebrew School tuition of $525.00 to Chabad Jewish Center Greater S. Petersburg in three equal payments of $175.00. The first payment will be paid with registration, and each payment following will be paid on or by December 2019 and March 2020.
Card Information
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Card Number
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Expiration
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CVV Security Code
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Name on Card
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Charge Amount
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Comments/Questions
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