We are currently accepting application forms for the 2020-2021 school year. Please fill out ALL fields of this form. If you have any questions or concerns you would like to discuss with us, please feel free to contact us.

Are you an existing student, returning for the new year? Register here.

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

 

Student Profile
 
Last Name
First Name
Hebrew Name
Age
DOB
Time of Birth AMPM
School
Grade Entering
Hebrew Reading Proficiency None Somewhat Well
Previous Jewish Education Yes No
Where?

 

Parent Information
 
Address
City/Zip
Phone
Father's Name
Father's Occupation
Father's Cell
Father's Email
Mother's Name
Mother's Occupation
Mother born Jewish? Converted by whom?
Mother's Cell
Mother's Email

 

Emergency Information
 
Emergency Contact 1
Phone
Emergency Contact 2
Phone
Doctor's Name
Doctor's Phone Number
Medical Insurance Company

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.



Tuition Information
 
PAYMENT OPTIONS | $675 + $25 BOOK FEE (REGISTER FOR FAMILY MEMBERSHIP & RECEIVE 50% OFF)
 Family Membership ($770+ 50% off each child's tuition+ membership perks)  
 $675 + $25 Book Fee  

 Kindergarten Program, Free of Charge

*There are different membership options and many perks that come along with membership. Call 516.764.7385    
 
EARLY BIRD SPECIAL! (PAYMENT MUST BE GIVEN IN FULL TO RECEIVE EARLY BIRD)
 Yes, I'm registering before June 15, 2020 and would like to receive the $50 discount.
 
Payment Information
 
PLEASE CHOOSE ONE OF THE FOLLOWING PAYMENT OPTIONS:
 One Full Tuition Payment
 10 Equal payments charged on the first of each month August - May
 
PAYMENT METHOD
 Please Charge My Card Below 
 Check (postdated checks if paying in 10 equal payments)
       
Name on Card Billing Address
Billing Zip Credit Card Type
Credit Card Number Exp Date
CVV Amount to Charge

 

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: Date:

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