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. No. of Students registering* Student Profile 1 Registration Type* New Student Returning Student Full Name* First Name Last Name Hebrew Name* If unknown / none, write 'unknown' or 'none' Age* Date of Birth* Include approx. time of birth Month Day Year at 1 2 3 4 5 6 7 8 9 10 11 12 Hour 00 10 20 30 40 50 Minutes AM PM School* Grade Entering* Pre-K Kindergarten First Second Third Fourth Fifth Sixth Seventh Eighth Please enter any changes from previous year Hebrew Reading Proficiency* None Somewhat Well Previous Jewish Education* Yes No Where?* Does your child have allergies?* Food or medication Yes No Please describe allergies* Does your child take medication regularly?* Yes No Please outline medication* Does your child have an IEP?* Yes No Please list the details of the IEP and any special services your child receives* Please list any special needs that may require special awareness from our staff* Special needs including physical, developmental, learning, emotional or behavioral Student Profile 2 Registration Type* New Student Returning Student Full Name* First Name Last Name Hebrew Name* If unknown / none, write 'unknown' or 'none' Age* Date of Birth* Include approx. time of birth Month Day Year at 1 2 3 4 5 6 7 8 9 10 11 12 Hour 00 10 20 30 40 50 Minutes AM PM School* Grade Entering* Pre-K Kindergarten First Second Third Fourth Fifth Sixth Seventh Eighth Please enter any changes from previous year Hebrew Reading Proficiency* None Somewhat Well Previous Jewish Education* Yes No Where?* Does your child have allergies?* Food or medication Yes No Please describe allergies* Does your child take medication regularly?* Yes No Please outline medication* Does your child have an IEP?* Yes No Please list the details of the IEP and any special services your child receives* Please list any special needs that may require special awareness from our staff* Special needs including physical, developmental, learning, emotional or behavioral Student Profile 3 Registration Type* New Student Returning Student Full Name* First Name Last Name Hebrew Name* If unknown / none, write 'unknown' or 'none' Age* Date of Birth* Include approx. time of birth Month Day Year at 1 2 3 4 5 6 7 8 9 10 11 12 Hour 00 10 20 30 40 50 Minutes AM PM School* Grade Entering* Pre-K Kindergarten First Second Third Fourth Fifth Sixth Seventh Eighth Please enter any changes from previous year Hebrew Reading Proficiency* None Somewhat Well Previous Jewish Education* Yes No Where?* Does your child have allergies?* Food or medication Yes No Please describe allergies* Does your child take medication regularly?* Yes No Please outline medication* Does your child have an IEP?* Yes No Please list the details of the IEP and any special services your child receives* Please list any special needs that may require special awareness from our staff* Special needs including physical, developmental, learning, emotional or behavioral Parent Information Address* Street Address Street Address Line 2 City State / Province Postal / Zip Code Please Select United States Afghanistan Albania Algeria American Samoa Andorra Angola Anguilla Antigua and Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan The Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bosnia and Herzegovina Botswana Brazil Brunei Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Chile People's Republic of China Republic of China Christmas Island Cocos (Keeling) Islands Colombia Comoros Congo Cook Islands Costa Rica Cote d'Ivoire Croatia Cuba Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Eswatini Ethiopia Falkland Islands Faroe Islands Fiji Finland France French Polynesia Gabon The Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guernsey Guinea Guinea-Bissau Guyana Haiti Honduras Hong Kong Hungary Iceland India Indonesia Iran Iraq Ireland Israel Italy Jamaica Japan Jersey Jordan Kazakhstan Kenya Kiribati North Korea South Korea Kosovo Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macau Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia Moldova Monaco Mongolia Montenegro Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island Northern Mariana Norway Oman Pakistan Palau Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Islands Poland Portugal Puerto Rico Qatar Romania Russia Rwanda Saint Barthelemy Saint Helena Saint Kitts and Nevis Saint Lucia Saint Martin Saint Pierre and Miquelon Saint Vincent and the Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands Somalia Somaliland South Africa South Ossetia Spain Sri Lanka Sudan Suriname Svalbard Sweden Switzerland Syria Taiwan Tajikistan Tanzania Thailand Timor-Leste Togo Tokelau Tonga Trinidad and Tobago Tristan da Cunha Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu Uganda Ukraine United Arab Emirates United Kingdom Uruguay Uzbekistan Vanuatu Vatican City Venezuela Vietnam British Virgin Islands US Virgin Islands Wallis and Futuna Western Sahara Yemen Zambia Zimbabwe Other Country Father* First Name Last Name Father's Occupation* Father's Cell* Area Code Phone Number Father's Email* Mother* First Name Last Name Mother's Occupation* Mother's Cell* Area Code Phone Number Mother's Email* Mother born Jewish?* Yes No Converted by whom?* Referred by* Emergency Information Emergency Contact 1* First Name Last Name Phone Number* Area Code Phone Number Emergency Contact 2* First Name Last Name Phone Number* Area Code Phone Number Doctor's Name* Doctor's Phone Number* Area Code Phone Number Medical Insurance Company* Tuition Information Tuition cost is $700 + $25 Book Fee. For members, tuition is discounted 50% or free (for first two children) Registration Type* Member registration Non Member Registration Membership Status* I would like to renew my membership I would like to become a new member Membership Packages Membership Package Family Membership $900 - includes 3 free seats for HH, 50% off Hebrew school tuition (for 2 kids) Platinum Membership $1,800 - includes basic membership, plus unlimited seating for the HH and two tickets to an exclusive donor evening, Free CHS tuition(for 2 kids) Chai Society Membership The CHAI SOCIETY Members are the pillars of our community. It is because of you that we can continue to offer the highest level of educational, religious and social programming, and making this all available to all, regardless of their ability to pay. In appreciation, Chai Society Members are listed on the Chabad Letterhead and website, and are entitled to a complimentary table of 10 at the Chabad bi-annual Gala Dinner. Chai Society Level CHAI Donor $3,600 - includes basic membership, plus unlimited seating, two tickets to an exclusive donor evening, and a monthly delivery of Soshie’s delicious challahs CHAI partner $5,000 - includes basic membership, plus unlimited seating, two tickets to an exclusive donor evening, ,a monthly delivery of Soshie’s delicious challahs, admitted to any Chabad program gratis CHAI Rabbis Circle $10,000+ includes basic membership, plus unlimited seating, two tickets to an exclusive donor evening, a weekly delivery of Soshie’s delicious challahs,admitted to any Chabad program gratis, and members will receive a prominent Aliya during the High Holidays Family Info Please indicate any information that needs to be updated from last year* Comments* Parent and children info will be included in your membership package as input above. Father's Hebrew Name* Mother's Hebrew Name* Marital Status* Married Divorced Widowed Single Which are you?* Kohen Levite Israelite No. of additional children (not input above)* Additional Child 1* First Name Last Name Hebrew Name* Birth Date* 1 - January 2 - February 3 - March 4 - April 5 - May 6 - June 7 - July 8 - August 9 - September 10 - October 11 - November 12 - December Month 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Day 2022 2021 2020 2019 2018 2017 2016 2015 2014 2013 2012 2011 2010 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959 1958 1957 1956 1955 1954 1953 1952 1951 1950 1949 1948 1947 1946 1945 1944 1943 1942 1941 1940 1939 1938 1937 1936 1935 1934 1933 1932 1931 1930 1929 1928 1927 1926 1925 1924 1923 1922 1921 1920 Year Gender* Boy Girl Additional Child 2* First Name Last Name Hebrew Name* Birth Date* 1 - January 2 - February 3 - March 4 - April 5 - May 6 - June 7 - July 8 - August 9 - September 10 - October 11 - November 12 - December Month 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Day 2022 2021 2020 2019 2018 2017 2016 2015 2014 2013 2012 2011 2010 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959 1958 1957 1956 1955 1954 1953 1952 1951 1950 1949 1948 1947 1946 1945 1944 1943 1942 1941 1940 1939 1938 1937 1936 1935 1934 1933 1932 1931 1930 1929 1928 1927 1926 1925 1924 1923 1922 1921 1920 Year Gender* Boy Girl Additional Child 3* First Name Last Name Hebrew Name* Birth Date* 1 - January 2 - February 3 - March 4 - April 5 - May 6 - June 7 - July 8 - August 9 - September 10 - October 11 - November 12 - December Month 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Day 2022 2021 2020 2019 2018 2017 2016 2015 2014 2013 2012 2011 2010 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959 1958 1957 1956 1955 1954 1953 1952 1951 1950 1949 1948 1947 1946 1945 1944 1943 1942 1941 1940 1939 1938 1937 1936 1935 1934 1933 1932 1931 1930 1929 1928 1927 1926 1925 1924 1923 1922 1921 1920 Year Gender* Boy Girl Additional Child 4* First Name Last Name Hebrew Name* Birth Date* 1 - January 2 - February 3 - March 4 - April 5 - May 6 - June 7 - July 8 - August 9 - September 10 - October 11 - November 12 - December Month 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Day 2022 2021 2020 2019 2018 2017 2016 2015 2014 2013 2012 2011 2010 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959 1958 1957 1956 1955 1954 1953 1952 1951 1950 1949 1948 1947 1946 1945 1944 1943 1942 1941 1940 1939 1938 1937 1936 1935 1934 1933 1932 1931 1930 1929 1928 1927 1926 1925 1924 1923 1922 1921 1920 Year Gender* Boy Girl 1 Child - Non Member 2 Child - Non Member 3 Child - Non Member 1 Child - Member 2 Child - Member 3 Child - Member 3 Child - Platinum Member Total $0.00 Payment Options Payment Options* I would like to pay the full amount today I would like to set up a payment plan Total Amount to charge today* Amount to charge monthly* Payment Credit Card Check Credit Card Visa MasterCard American Express Discover Credit Card Type Credit Card Number Security Code Name on Card 1 - January 2 - February 3 - March 4 - April 5 - May 6 - June 7 - July 8 - August 9 - September 10 - October 11 - November 12 - December Expiration Month 2022 2023 2024 2025 2026 2027 2028 2029 2030 2031 Expiration Year Billing Address Street Address Street Address Line 2 City State / Province Postal / Zip Code Please Select United States Afghanistan Albania Algeria American Samoa Andorra Angola Anguilla Antigua and Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan The Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bosnia and Herzegovina Botswana Brazil Brunei Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Chile People's Republic of China Republic of China Christmas Island Cocos (Keeling) Islands Colombia Comoros Congo Cook Islands Costa Rica Cote d'Ivoire Croatia Cuba Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Eswatini Ethiopia Falkland Islands Faroe Islands Fiji Finland France French Polynesia Gabon The Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guernsey Guinea Guinea-Bissau Guyana Haiti Honduras Hong Kong Hungary Iceland India Indonesia Iran Iraq Ireland Israel Italy Jamaica Japan Jersey Jordan Kazakhstan Kenya Kiribati North Korea South Korea Kosovo Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macau Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia Moldova Monaco Mongolia Montenegro Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island Northern Mariana Norway Oman Pakistan Palau Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Islands Poland Portugal Puerto Rico Qatar Romania Russia Rwanda Saint Barthelemy Saint Helena Saint Kitts and Nevis Saint Lucia Saint Martin Saint Pierre and Miquelon Saint Vincent and the Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands Somalia Somaliland South Africa South Ossetia Spain Sri Lanka Sudan Suriname Svalbard Sweden Switzerland Syria Taiwan Tajikistan Tanzania Thailand Timor-Leste Togo Tokelau Tonga Trinidad and Tobago Tristan da Cunha Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu Uganda Ukraine United Arab Emirates United Kingdom Uruguay Uzbekistan Vanuatu Vatican City Venezuela Vietnam British Virgin Islands US Virgin Islands Wallis and Futuna Western Sahara Yemen Zambia Zimbabwe Other Country CVV Security Code Additional Comments Submit Should be Empty: This page uses TLS encryption to keep your data secure.
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