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2019 - 2020 School Year registration.
P lease fill out ALL fields of this form.

We are proud to announce that Hebrew School will be under the direction of Rabbi Adi and Malky Goodman. Feel free to contact them at RabbiAdi@gmail.com or Malkygoodman@gmail.com Looking forward to a great year in Hebrew School!

Hebrew School Sunday Mornings - 10:00am - 12:15pm
Ckids Club - About twice Monthly on a weeknight.

Classes will be located at the new Chabad of SW Broward campus.
Until the new campus will be available, our Temporary location will be held at Chabad at Monterra

Hebrew School honors the family membership discounts for $100 monthly level members or above from
Chabad of SW Broward and Chabad at Monterra.

In order to receive a membership discount, please sign up prior to submitting the below registration form for your child(ren). .
Click on link below to access the Chabad membership link.

Chabad of SW Broward Membership Form - Chabad at Monterra Membership Form

FAMILY INFORMATION:
Family Name:
Home Phone:
Address:
City, State, Zip:
Mother's Information
Name:
Hebrew Name:
Birthday:
Address: (if different)
Home Phone: (if different)
Cell:
Work:
Email:
Father's Information
Name:
Hebrew Name:
Birthday:
Address: (if different)
Home Phone: (if different)
Cell:
Work:
Email:
Marital Status:
Child resides with:	If other, please specify:

STUDENT INFORMATION - CHILD 1

Name:
Hebrew Name:
Date of Birth:
City of Birth:
Time of Birth:	AM PM
Time of Birth:	AM PM
School:
Grade in Sept. 2019:

STUDENT INFORMATION - CHILD 2

Name:
Hebrew Name:
Date of Birth:
City of Birth:
Time of Birth:	AM PM
Time of Birth:	AM PM
School:
Grade in Sept. 2019:

GENERAL INFORMATION

Is the natural mother of the child Jewish? YesNo
Is the mother's mother Jewish? Yes No
Is the natural father of the child Jewish? Yes No
Is the father's mother Jewish? Yes No
Have there been any conversions or adoptions in the family history?
Has your child(ren) attended Hebrew School before?
If yes, where and for how long?
Does your child(ren) have any learning disabilities with general studies? Please specify.

Special Instructions (allergies, etc):
Emergency Contact (Besides Parent):
Name:	Phone number:
Persons authorized to pick up my child(ren):
What are some of the goals you hope your child will achieve through attending the Chabad Hebrew School?
How did you hear about CHS? (Check all that apply for this year) Facebook Internet Search Referred by: Other:

TUITION

Kindergarten - 7th Grade general tuition fees:(Including Ckids Program)

$700.00 ........ Chabad Member (Chabad of SW Broward or Chabad at Monterra $100 monthly member level or higher)
$1000.00 ...... Non paid member

Additional Fees:

$125.00 ...... Registration & book fee (per child)
$75.00 ........ Security Fee

*Sibling discount - $75 per sibling

Payment Plans - ALL PAYMENTS MUST BE PAID IN FULL BY JANUARY15,2020

1 Check / Credit Card* payment in full (due before the first day of Hebrew School)

Please divide my Check payment into installments, for deposit on the 15th of each month. All post-dated checks must be submitted with registration.

Please divide my Credit Card* into installments to be charged on the 15th of each month.

Card Number: Exp: Security Code:

Zip Code:

*A service charge of 3.5% will be added to all tuition and fee payments made by credit card.

I would like to assist a child who cannot afford Hebrew School Education.

AGREEMENT

Please enroll my child(ren) in Chabad Hebrew School! (please check the applicable box below)

Chabad Member enrolling one child + fees $900 Chabad Non-Member enrolling one child + fees $1,200

Chabad Member enrolling two children + fees ($75 discount) $1,725 Chabad Non-Member enrolling two children + fees ($75 discount) $2,325

Chabad Member enrolling three children + fees ($150 discount) $2,550 Chabad Non-Member enrolling three children + fees ($150) discount $3,450

Admissions: This signed registration form along with full payment or completed and approved payment plan must be submitted to the school office before any child will be permitted to attend classes. Registration and enrollment is only complete after payment plan approval and registration fees are received. Refund Policy: Refunds for children withdrawing from school before the end of the school year will be pro-rated up to February 1st provided that the school office is given 30 days written notice. Tuition refunds will not be granted to children withdrawing from school after February 1. Registration and book fees are non-refundable. There are no refunds or credits for days missed due to illness, holidays, or family vacations.

Emergency plan: I 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/us prior to such treatment.

Miscellaneous: I allow my child to be photographed while participating in Hebrew School activities and for these photographs to be used in the marketing of Chabad activities. I understand that all liability and costs resulting from damage to property and/or personal injury caused or attributable to my child(ren)will be my responsibility and I agree to fully indemnify Chabad Lubavitch of Southwest Broward, Inc. and Chabad Hebrew School and its associates, teachers and agents harmless therefrom. I authorize my child(ren) to participate in trips conducted by Chabad Hebrew School.

I certify that I am the parent or legal guardian of the above listed child(ren), that I have read and understand the full agreement as published online at ChabadSWB.com, that I agree to pay full amount due and that I agree to all policies as set forth by Chabad Hebrew School.

Electronic Signature: Date: