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Register Online

Register Online

Download a Parents' Handbook

Register today to ensure a Jewish tomorrow. Please complete the form below.  If you have any questions, feel free to contact our Hebrew School principal, Rabbi Blesofsky, who will be happy to discuss your child with you! 718-279-1457 or click to email. 

Please note that one registration form per child is needed.
_________________________________________________________________________________

STUDENT INFORMATION

 Family Name

 

Is the natural mother of the child Jewish?
 Yes No

Were there any conversions or adoptions in the child's family?  Yes No - If yes, please explain

Has your child had any previous Hebrew Education?
 Yes No  --- If yes, where?

Does your child read basic Hebrew?  Yes No

 First Name  
 Hebrew Name  
 Date of Birth    
 Age   Sex   Grade  
School Attending  
Home Address  
 City, State, Zip  


PARENT INFORMATION

Father

  Mother
Father's Name   Mother's Name
Hebrew Name   Hebrew Name
Date of Birth /  /
MM / DD / YYYY format
  Date of Birth /  /
MM / DD / YYYY format
Home Tel.   Home Tel.
Work Tel.   Work Tel.
Cell #:   Cell #:
Occupation   Occupation
Email   Email

MEDICAL INFORMATION

Persons to be contacted in case of an emergency when parents cannot be reached (Please provide 2 contacts)

 Name

Phone

Relationship to Child

 Name

Phone Relationship to Child

 In an emergency, when you cannot reach either parent, I authorize the school to call:
 Family Physician Phone

I hereby consent to the administration of the Chabad Hebrew School to take whatever medical measures they deem necessary for my child in the even of a medical emergency. Parent/Legal Guardian Initials

TUITION AGREEMENT

The following document is a tuition agreement for the Chabad Hebrew School. The agreement explains the tuition fees, payments plans and refund policies. Please read it through carefully and sign it on the signature line below. The signed tuition agreement along with full payment must be submitted to the school office before any child will be permitted to attend classes. Refunds for children withdrawing from school before the end of the school year will be granted provided that the school office is given 30 days written notice. Tuition refunds will not be granted to children withdrawing from school after April 1st. A limited number of scholarships are available upon request; no child will be turned away for lack of funds.


PLEASE CHOOSE ON OF THE FOLLOWING TUITION OPTIONS
:

 Pay full tuition of $630.00 by credit card below.

 Divide my payments into 2 charges of $300.00

 

 2 postdated checks - Dated 9/1/09 and 2/1/10 Due by first day of School.
 2 credit card payments - Charged on 9/1/09 and 2/1/10.

PAYMENT INFO

Amount to be charged:

Please charge my:

Card #:
Exp. Date   
Cvv Code:
Optional Comments:

 

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