Hebrew School Registration

Applicants Name:*

First Name Last Name

Address:*

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Child 1 - Full Name:*

First Name Last Name

Child's Hebrew Name:*

Child 1 - Birth Date:*

Month Day Year

Time of Day Born:*

Before SunsetAfter Sunset

Child 1 - School:

Child 1 Grade:*

Child 2 - Full Name:

First Name Last Name

Child's Hebrew Name:

Child 2 - Birth Date:

Month Day Year

Time of Day Born:

Before SunsetAfter Sunset

Child 2 - School:

Child 2 - Grade:

Child 3 - Full Name:

First Name Last Name

Child's Hebrew Name:

Child 3 - Birth Date:

Month Day Year

Time of Day Born:

Before SunsetAfter Sunset

Child 3 - School:

Child 3 - Grade:

Additional notable Information: Please let us know any important information we should be aware of: (Allergies, Disabilities, Behaviors, etc.

Father's Name:*

First Name Last Name

Father's Hebrew Name:* *If you are unsure, please write NA

Father's Cell:*

Area Code Phone Number

Father's E-mail:*

Mother's Name:*

First Name Last Name

Mother's Hebrew Name:* *If you are unsure, please write NA

Mother Jewish by:*

BirthChoice

Mother's Cell:*

Area Code Phone Number

Mother's E-mail:*

Best way to send Hebrew School updates:*

Cell PhoneEmailHandout

I am willing to assist in school activities, please contact me

Contact 1:* *Other than parents*

First Name Last Name

Phone Number:*

Area Code Phone Number

Relationship:*

Contact 2:* *Other than parents*

First Name Last Name

Phone Number:*

Area Code Phone Number

Relationship:*

Physician Name:*

Phone Number:*

Area Code Phone Number

Address*

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Does your child have any allergies?*

YesNo

If YES, please specify:

Does your child carry an Epi-Pen?*

YesNo

Is there any other medical information that we need to know about?*

YesNo

If YES, please specify:

Tuition Fees:

$1,000.00: Total per student - Chabad Member
$1,200.00: Total per student - Non Chabad Member

*Sibling discount* - $75 per sibling

Trial Day: $50 credit towards the price of tuition.

Please Choose your tuition amount:*

Total:

$0.00

Payment Plan:* Please select your preferred payment plan

One Check or Credit Card paymentDivide tuition into 5 payments charged on the 5th of every month.

Payment Method:*

Credit Card Check

Postal / Zip Code

Country

Agreement

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 * Please enter name as signature

I would like to receive news and updates by email

Hebrew School Registration Form 2024/2025

Hebrew School Registration 2024/2025

Student Information

Parents Information

Emergency Contact and Medical Information

Payment

Our Shul

Adult Education

Youth Programs

Holiday Celebrations

Women's Events

Hebrew School