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Re-Enrollment.

Re-Enrollment.

Please note. This form is the Re-enrollment form. For initial enrollment, Click Here

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

 

Application form.

Please note - This is an application form only.

Student Profile
 
First Name(s)
Last
Parent Information
 
Father's Name
Phone
Mother's Name
Phone
Address
City
State
Zip
Email Addresses

 

Emergency Information
 
Emergency Contact 1
Phone
Emergency Contact 2
Phone

Doctor
Address
Phone

CONFIDENTIAL: Does your child have any allergies, food restrictions or other medical condition we should be aware of? If yes, please describe them and indicate special precautions or care needed. Is there anything else that you think would be helpful for us to know about your child?

 

Payment Information

2017/18

$750/child. Sibling discount: 10% per child.

Early Bird Discount - Register Before June 30 - $695/Child

 
Contact Details
Title
City
First Name
State / Zip
/
Last Name
Phone
Address
Email
This is my home address
This is my business address
Credit Card Details
Total To be Charged TODAY

 
Card Number
Expiration Date: (MM/YYYY)
Card Type
CVV Security Code


 

 

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!

 

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