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.

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

Hebrew school is on Sundays from 10:00 AM-12:00 PM. 

RETURNING STUDENTS
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NEW STUDENTS 
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Student Profile 1
   
Last Name
First Name
Hebrew Name (if unknown / none, write 'unknown' or 'none')
Age
DOB
Time of Birth AMPM
School
Grade Entering
Hebrew Reading Proficiency None Somewhat Well
Previous Jewish Education Yes No
Where?   
Does your child have allergies?(Food or medication)  No  Yes - What Kind? 
Does your child take medication regularly?  No  Yes - what Kind?  
Does your child have an IEP?  No  Yes
Please list the details of the IEP and any special services your child receives 
Please list any special needs(physical, developmental, learning, emotional, behavioral) that may require special awareness from our staff

 

   
Student Profile 2
   
Last Name
First Name
Hebrew Name (if unknown / none, write 'unknown' or 'none')
Age
DOB
Time of Birth AMPM
School
Grade Entering
Hebrew Reading Proficiency None Somewhat Well
Previous Jewish Education Yes No
Where?   
Does your child have allergies?(Food or medication)  No  Yes - What Kind? 
Does your child take medication regularly?  No  Yes - what Kind?  
Does your child have an IEP?  No  Yes
Please list the details of the IEP and any special services your child receives 
Please list any special needs(physical, developmental, learning, emotional, behavioral) that may require special awareness from our staff

 

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 MEMBERSHIP & RECEIVE % OFF)
  Family Membership ($770+ 50% off each child's tuition+ membership perks) 
  Platinum Membership (includes basic membership, plus unlimited seating and two tickets to an exclusive donor evening, Free CHS tuition (for 2 kids)
 $675 + $25 Book Fee 
*There are different membership options and many perks that come along with membership. Call 516.764.7385    
 
 How did you hear about Chabad Hebrew School?         
 I was referred to Chabad Hebrew School. By Who? 
 
In order to complete your application please click here to set up a 15 minute meeting with the directors.
 
Payment Information
 
 
PAYMENT METHOD
 Use the same card that I paid membership with

 Please Charge My Card Below 


Name on Card  
Billing Address
Billing Zip  
Credit Card Type
Credit Card Number  
Exp Date
CVV  

Additional Comments 

 

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!