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
Student Information
Male Female
Does your child have previous Jewish Education Yes No  
If yes, please describe:
What school does your child attend? Grade entering:
Synagogue affiliated with:  
Is the natural mother of the child Jewish? Yes No  
Were there any conversions or adoptions in your family? Yes No  
If yes, please describe:
Does your child read basic Hebrew? None Somewhat Well
Does your chld have any difficulty with general studies?
Parent Information  
Emergency Contact Information
Please list two contacts to be used in case of emergencies (other than your home and business numbers).
Accept Do Not Accept

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

Card Number
CVV Security Code
Name on Card

Charge Amount