We are currently accepting application forms for the 2018-2019 school year. Please fill out ALL fields of this form. If you have any questions or concerns you'd like to discuss with us, please contact us.

Please note that one registration form per child is needed. The classes are split by age group: 5-6, 7-8, 9-10.

We look forward to a wonderful year of learning and growth!

Student Profile
First Name
Last Name
Hebrew Name
Class (There are 2 separate classes)
DOB
School
Grade Entering
Hebrew Reading Proficiency None Somewhat Well
Previous Jewish Education Yes No
Where?

Family Information
My child is a
Are the natural father and mother of the child Jewish? Yes No
If no, please explain.
Have there been any conversions or adoptions in the family? Yes No
If yes, please explain.
Parent Information
Father's Name
Mobile
Mother's Name
Mobile
Home Phone
Address
City
Zip
Email*
* Email address allows us to communicate in the most efficient and economical manner. We do not use your address for other puropses.
Emergency Information
Emergency Contact 1
Phone
Relationship
Emergency Contact 2
Phone
Relationship
CONFIDENTIAL: Does your child have any allergies or other medical condition we should be aware of? If yes, please describe them and indicate special precautions or care needed.
Rate and Agreement
Date and Rate Tuesdays, 3:30 - 5:00pm | Cost Per Child: $1650
I Accept Terms of Agreement
In the event of an emergency, Chabad Israel Hebrew School has my permission to arrange for any necessary first-aid or care by a licensed physician/first-aid worker. Chabad Israel Hebrew School has my permission to use my child's photo in its publicity materials. I have completed the Enrollment Form and agree to pay any balance according to the terms of agreement outlined above.
  Name: Initials:
Payment Information
First Name
Last Name
Zip
Amount:
Card Type
Card Number
Exp. Date
CVV
Comments