REGISTRATION FORMregistration form.jpg 

Registration Form

 

Student's Name:                                

Hebrew Name:                                   

Birth Date:  /    /      /

Telephone # Cell Phone:                       

Address:                                       

Synagogue Affiliation:                        

School Name & City:                       

Mothers Name                       

Mothers Hebrew Name:                       

Fathers Name                       

Fathers Hebrew Name:                       

Is the natural mother of the child Jewish?______

Are there any conversions or adoptions in the family history? *                       

Please list Bet Din (court of Jewish Law)  and Rabbinic Authority involved in conversion or adoption:                                            

 

* These questions enable us to better serve our constituents. All information will remain confidential.

 

About your child:

Describe basic Judaic knowledge: (previous Hebrew School Education, Hebrew reading, holidays) 

                                                                                                                                             

Does your child have any learning difficulties with general studies?

Explain                                              

Is there anything you want us to know about our child that would help us to help him/her?                                                                     

 

 GENERAL

Does either parent have any special resources or skills to offer our children or teachers?

                                                                            

Details:                                                                                                   

Would you be willing to help with school activities? yes/no 

The following are authorized to take my child to and from school:

Name:                                                

Phone:                                               

Relationship to child :                                                                            

 

 

Medical and Emergency Information:

Add names of two people who will take responsibility for your child in case of emergency.

Name                                             

Phone                                             

Address                                          

Relationship to child                            

 

Name                                             

Phone                                             

Address                                          

Relationship to child                            

In case of emergency, when neither parent can be reached, permission is given to the school staff to phone child’s doctor:

Doctor                            

Phone                            

Address                            

City                                

Hospital Affiliation:                            

Signature:                            

If parents cannot be reached and emergency medical advice or care is needed,  

􀂋 I authorize the paramedics to take my child to the nearest hospital

Signature:                            

 

 

Medication child is taking on a regular basis:

                                                                                               

 

Any special medical allergy or condition:

                                                                                                 

Parent’s signature

                                                                                                 

Date                            

  

 

Tuition is $550.00 including non refundable registration fee of $50**

Please choose method of payment.

Payment Card:

 Please find enclosed:           for tuition for my child/ren. 

 􀂋Cash, 􀂋Check #

 􀂋Credit Card #                                 

** We will NEVER turn away a child for lack of funds. If you require a Scholarship, please call or email our office.

Payment plans are available. Please call office to set up personalized payment plan.  

Complete registration form and submit with tuition.

 

Mail to : Chabad Hebrew School

 7942 W Bell Rd, C5 #101

Glendale, AZ 85308