Register Online

Please fill out this form as an initial registration for Chabad Hebrew School of the Arts 2023/24
Student Information
Full Name*

First Name Last Name
Hebrew Name
Age*
Gender*

MaleFemale
Birth Date*

Month Day Year
Does your child have previous Jewish Education*

YesNo
If yes, please describe:
What school does your child attend?*
Grade entering: *
Synagogue affiliated with:*
Is the natural mother of the child Jewish?*

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

YesNo
If yes, please describe:
Does your child read basic Hebrew?*

NoneSomewhatWell
Does your chld have any difficulty with general studies?
Parent Information
Father's Name*

First Name Last Name
Work Phone Number

Area Code Phone Number
Occupation*
Cell Phone Number*

Area Code Phone Number
E-mail*

Address*

Address (if different than above)

Emergency Contact Information

Please list two contacts to be used in case of emergencies (other than your home and business numbers).
Emergency Contact (other than parent)*

First Name Last Name
Relationship to Child*
Phone Number*

Area Code Phone Number

Address*

Additional person authorized to pickup your child (besides parents/guardians)*

First Name Last Name
Relationship to Child*
Phone Number*

Area Code Phone Number

Address*

Address*

As the parent(s) or legal guardian of the above child, I/we authorize any adult acting on behalf of Chabad Hebrew School to hospitalize or secure treatment for my child, I further agree to pay all charges for that care and/or treatment. It is understood that if time and circumstances reasonably permit, Chabad Hebrew School personnel will try, but are not required, to communicate with me prior to such treatment. I hereby give permission for my child to participate in all school activities, join in class and school trip on and beyond school properties and allow my child to be photographed while participating in Chabad Hebrew School activities.
*

AcceptDo Not Accept
Payment Information
Tuition: Early bird Special: Register by July 5th and save $100! Refer a friend for additional $50 savings.
Early Bird Special (by July 20, 2023) $500 includes tuition, registration & book fee.
Payment in Full (after July 20, 2023) $600 includes tuition, registration & book fee.

Scholarships are available. Please contact the office at 344-4900 for further details.

No child will be turned away for lack of funds!

Payment*

Credit Card Check

Postal / Zip Code

Country

This page uses TLS encryption to keep your data secure.

Student Information