HEBREW SCHOOL REGISTRATION

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.

At the bottom of the registration form please be sure to fill out the information needed for registration. There is a $50 registration fee. Tuition can either be billed to you or charged now.

Classes for the 2018-2019 school year will be held on Sunday mornings from 9:45-11:45.
Please note that one registration form per child is needed.

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

STUDENT INFORMATION
First Name   Last Name
Hebrew Name   D.O.B.
School   Grade Entering
Hebrew Reading Proficiency None Somewhat Well
Previous Jewish Education Yes No If yes - where?
Father's Hebrew Name
Mother's Hebrew Name

 

PARENT INFORMATION
Father's Name   Father's Cell
Mother's Name   Mother's Cell
Address   City, State, Zip
City State Zip
Home Phone   Email
Were there any conversions or adoptions in the family? Yes No
If yes, please explain:

 

EMERGENCY INFORMATION
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.



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:

PAYMENT OPTIONS

• Tuition for the coming year will be $535, which includes $30 book and $55 registration fees.
• $100 will be charged now (unless otherwise noted by you) and the remaining tuition balance can be paid by check, mailed to
Chabad Hebrew School • 521 A1a N • Ponte Vedra Beach, Fl 32082

Name on card   Card Type
Charge Amnt.   Card Number
Exp. Date   CVV Code 3 digits on back of card