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Register

Register

We are currently accepting application forms for the 2016-17 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.

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

Student Information
Child 1:
Child's Name Hebrew Name
Date of Birth School
Grade Entering Hebrew Reading Proficiency None Somewhat Well
Previous Jewish Education Yes No Where?
Child 2: (if applicable)
Child's Name Hebrew School
Date of Birth School
Grade Entering Hebrew Reading Proficiency None Somewhat Well
Previous Jewish Education? Yes No Where?
Is the natural mother and maternal grandmother of the child Jewish? Yes No
Have there been any conversions or adoptions in the family? If Yes, please explain.

Parent Information
Father's Name Email
Work Phone Cell Phone
Mother's Name Email
Work Phone Cell Phone
Address City
State Zip
Emergency Informaion
Emergency Contact 1 Phone
Emergency Contact 2 Phone
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.
Payment Information
Chabad Hebrew School Tuition for the complete year is $540 for Sundays only or $765 for Sundays and Wednesdays (per child).
Please note: There is an additional $50 Registration fee and $25 book fee per child.
DISCOUNTS: Tuition PAID IN FULL before SEPT 1st will receive 5% off.
Please select payment plan:
Plan A - Payment in full before beginning of academic year - check, cash or credit card
Plan B - 50% paid before beginning of academic year and 50% due by Jan
Plan C - Please call me. I'd like to discuss tuition over the phone or in person
Payment Method Checks can be mailed to 1190 A1A, Satellite Beach, FL
Card Number Billing Address
Expiration CVV Code What's This?
Terms of Enrollment

As the parent(s) or legal guardian of the above child(ren), 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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