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CHS Registration 2017-18

CHS Registration 2017-18

Chabad Hebrew School
Directors: Rabbi Yehuda & Dina Kantor

REGISTRATION 2017 - 18
FIRST DAY: SEPTEMBER 10
CLICK HERE FOR CALENDAR

Family Information
Family Name   Father's Name   Hebrew Name
      Mother's Name   Hebrew Name
MY INFORMATION IS THE SAME AS LAST YEAR - Check for yes . If no, please complete this section.
Home Phone   Home Address   City, State, Zip
Father's Cell #   Father's Work #   Father's Email
Mother's Cell #   Mother's Work #   Mother's Email
Are there any conversions in your family (including parents / grandparents)? No Yes

If yes, paternal or maternal?

     
               
Student 's Information (Returning students need only enter name and grade. New Students please complete in full)
Student #1
Full Name   Hebrew Name   Called By
Age   Date of Birth
  Grade 9/16
Previous Hebrew Education Number of Years
         
Student #2
Full Name   Hebrew name   Called By
Age   Date of Birth
  Grade 9/16
Previous Hebrew Education Number of Years
         
Student #3
Full Name   Hebrew name   Called By
Age   Date of Birth
  Grade 9/16
Previous Hebrew Education Number of Years
   
Health Information
Emergency Contact
           
Name   Relationship   Phone

Please list any health problems, medications, or health information we need to know

               
Payment Information ($500 deposit per student required at Registration)
Tuition:
Grades K - 2 Sunday only 9:30 - 11:30 AM $ 900.00
Grades 3 & Up Sunday 9:30 - 11:30 AM & Tuesday 4 - 6 PM $ 1550.00
7th Grade led by Rabbi Kantor Tuesday only - 4 - 6 PM   $ 900.00
(mandatory for Bar/Bat mitzvah)      
Mandatory Security Fee   $ 136.00
I would like to help a child! CHS Scholarship Fund Donation Amount:  

I will send in a check for deposit/payment ($500 deposit/student required at registration)
 

Please add the mandatory Security Fee of $136 per family
Name on Card   Card Type   Card Number
Expiration   CVV   Total Charge

I hereby permit my Child(ren) to participate in all school activities and join in school trips on and beyond school properties. In case of emergency, I hereby authorize the school to have my child taken care of by a physician in any way the situation may call for. (Please note - checking this box constitutes a signed authorization.)

I am willing to assist in school activities. Please contact me.

 

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