Printed from JewishVail.com

Registration Form

Registration Form

Register Online

We are currently accepting application forms for the 2016-2017 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.

If you would prefer to fill out this paper and mail it into our office, a PDF can be found here.

Please note that one registration form per child is needed.

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

Student Profile
 
Name
Last
Hebrew Name
DOB            
School
Grade Entering
Hebrew Reading Proficiency None    Somewhat    Well
Previous Jewish Education Yes            No
Where?

Parent Information
 
Father's Name
Phone
Mother's Name
Phone
Address
City
State
Zip
Email Address

Emergency Information
 
Emergency Contact 1
Phone
Emergency Contact 2
Phone
Payment Information
 
Name On Card
Card Number
Exp. Date
Zip Code
CVV
Please consider an added donation to our scholarship fund
Total



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. 


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 trips on and beyond school properties and allow my child to be photographed while participating in Chabad Hebrew School activities and that these pictures may be used for marketing purposes.

I Accept   

Name:
    Initials:

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

 

Secure This page uses 128 bit SSL encryption to keep your data secure.