Printed from ChabadBriarcliff.com

Hebrew School Registration Form

Hebrew School Registration Form

ENROLLMENT FORM

Chabad Hebrew School 2017-2018

Family Name:

1. Child's First Name:

Hebrew Name:

Date of Birth: Grade (2016-17):

2. Child's First Name: Hebrew Name:

Date of Birth: Grade (2016-17):

3. Child's First Name: Hebrew Name:

Date of Birth: Grade (2016-17):

4. Child's First Name: Hebrew Name:

Date of Birth: Grade (2015-17):

  Click here if all the details are the same as last year - and then no need to refill this form, Go straight to the payment 

Address

City, State Zip

Home Phone

 

Mother (or Guardian name)

Occupation

Bus. Phone

Bus. Address

Cell Phone

E-mail



Father (or Guardian name)

Occupation

Bus. Phone

Bus. Address

Cell Phone

E-mail

 

 

 

S TUDENT I NFORMATION :

 

Is the biological mother Jewish? Yes No

 

Is the biological father Jewish? Yes No

Were there any conversions or adoptions in the family? Yes No

If Yes, who was the Rabbi?

Additional comments: any educational concerns that will help us with your child

 

 

Tuition and Fees

$1000 + $36 book and supply fee +$75 Security   - Free for first year K class

$350 for Hebrew school enrichment class on Wednesdays

I would like to sponsor the Jewish education of another child for $1000.

I would like to contribute $36 $72 $180 $360 other toward the Jewish education of another child.

Total:

 

Payment Options

Please check one:

I will send a check

Please charge my credit card

Credit Card Number

Expiration Date

 

Please call me to arrange a payment plan

 

Please send me a scholarship application form

*No child is turned away due to lack of funds
**Registration will not be not accepted without full payment or without a completed scholarship form or payment plan form.

 

 

I allow CHS to take pictures of my child/ren for our website and other PR purposes

Volunteer

I would like to volunteer at Chabad. My area of expertise

Computers Graphic Design
Handyman Dinner Committee
Organization Other

 

 


Emergency File

Doctor’s Name

Doctor's Phone

Doctor’s Address

Allergies

Medical Conditions

Other

P LEASE LIST BELOW T WO EMERGENCY CONTACTS :

Name Phone Relationship

Name Phone Relationship

PERMISSION FOR EMERGENCY MEDICAL TREATMENT:

As the parent(s) or legal guardian of , I/we authorize any adult acting on behalf of Chabad of Briarcliff's 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.

Initials of Parent or Legal Guardian

Comments:

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