We are currently accepting application forms for the 2021 -2022 school year. Please fill out ALL fields of this form. If you have any questions or concerns you'd like to discuss with us, please contact us. We look forward to a wonderful year of learning and growth. Student Information Child 1: Child's Name Hebrew Name Date of Birth Month Jan. Feb. Mar. Apr. May Jun. Jul. Aug. Sept. Oct. Nov. Dec. Date 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 Year 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 School Grade Entering Grade Entering Kindergarten First Second Third Fourth Fifth Sixth Seventh Hebrew Reading Proficiency None Somewhat Well Previous Jewish Education Yes No Where? Child 2: (if applicable) Child's Name Hebrew School Date of Birth Month Jan. Feb. Mar. Apr. May Jun. Jul. Aug. Sept. Oct. Nov. Dec. Date 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 Year 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 School Grade Entering Grade Entering Kindergarten First Second Third Fourth Fifth Sixth Seventh Hebrew Reading Proficiency None Somewhat Well Previous Jewish Education? Yes No Where? Is the natural mother and maternal grandmother of the child Jewish? Yes No Have there been any conversions or adoptions in the family? If Yes, please explain. Parent Information Father's Name Email Work Phone Cell Phone Mother's Name Email Work Phone Cell Phone Address City State Zip Emergency Informaion Emergency Contact 1 Phone Emergency Contact 2 Phone Confidential: Does your child have any allergies or other medical condition we should be aware of? If yes, please describe them and indicate special precautions or care needed. Payment Information Chabad Hebrew School Tuition for the complete year is $875. Sibling Discount $800 per child. Materials and Books: - $50. I understand that a $100 non refundable deposit, that will be applied towards tuition, will be charged to my credit card along with my form submission. Plan A - Pay in Full by Oct. 1 (10 % Discount). Total (Tuition + Books): $837.50 for single child Plan B - Two payments (Oct. & April) of $440.62 (5% Discount) Total (Tuition + Books): $881.25 Plan C - 10 Auto Monthly Payments of $92.50 Monthly Payments will be charged on the 5th of Every month. I will be requiring private Bar/Bat Mitzvah Lessons for my child - $54 per lesson I will like to sign my daughter up for the Bat Mitzvah Club - Annual cost: $250 • Payments can be submitted below or by mailing a check to Chabad Hebrew School, 151 Mullica Hill Rd. Mullica Hill, NJ 08062 Payment Method Select Pay online Check is in the Mail Card Number Expiration Month 01 02 03 04 05 06 07 08 09 10 11 12 Year 2017 2018 2019 2020 2021 2022 2023 2024 2025 CVV Code What's This? Billing Zip Name on Card Amount to Charge Card Terms of Enrollment As the parent(s) or legal guardian of the above child(ren), I/we 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 prior to such treatment. I hereby give permission for my child to participate in all school activities, join in class and school trips on and beyond school properties and allow my child to be photographed while participating in Chabad Hebrew School activities and that these pictures may be used for marketing purposes. I Accept Name: Initials: We look forward to a wonderful year of learning and growth! This page uses 128 bit SSL encryption to keep your data secure.