Name: Chabad Hebrew School 2021-22
Start: 2021-09-12
End: 2021-09-12

Student Information

RETURNING STUDENT
NEW REGISTRATION

New registration is not complete until confirmed wit h Rabbi Yossi & Leah

How many children will you be registering?

Child I Name*

Date of Birth*

Grade Entering*

Child II Name

Date of Birth

Grade Entering

Child III Name

Date of Birth

Grade Entering

What are some of your child(ren)'s interests?

Are there any allergies?*

Yes
No

If yes, please list allergies here:

What are some goals you have for your child(ren) attending CHS?

Family Information

Parent's Name*

First Last

Parent's Best Email*

Parent I Name*

First Last

Parent I Email*

Parent I Phone*

Parent I is:

Jewish
Jew by Choice
Not Jewish

Parent II Name*

First Last

Parent II Email*

Parent II Phone*

Parent II is:

Jewish
Jew by Choice
Not Jewish

Address*

Street Address City ZIP / Postal Code

Emergency Contact*

Emergency Contact Phone #*

Payment:

No child will be turned away for lack of funds.

Tuition

Total

$0.00

Payment Options:

Credit Card/ Paypal
Check
I would like to make a payment plan/ request a scholarship

Phone

This field is for validation purposes and should be left unchanged.

Chabad Hebrew School 2021-22

Student Information

Family Information

Payment:

Date

Time

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