Hebrew School Registration 2025-26 1. Parents Information Parental Marital Status* MarriedSeparatedDivorcedFather DeceasedMother DeceasedSingle Parent Your Name* First Name Last Name Your Email* Your Phone Number* I am the Child's* FatherMotherLegal Guardian Your Background* Jewish by birthJewish by conversionNot Jewish Home Address* Street Address Street Address Line 2 City State / Province Postal / Zip CodePlease SelectUnited StatesAfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanThe BahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChilePeople's Republic of ChinaRepublic of ChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongoCook IslandsCosta RicaCote d'IvoireCroatiaCubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonThe GambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorthern MarianaNorwayOmanPakistanPalauPanamaPapua New GuineaParaguayPeruPhilippinesPitcairn IslandsPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint BarthelemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSomalilandSouth AfricaSouth OssetiaSpainSri LankaSudanSurinameSvalbardSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTristan da CunhaTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamBritish Virgin IslandsUS Virgin IslandsWallis and FutunaWestern SaharaYemenZambiaZimbabweOther Country I authorize my telephone number and email address to be published in a class list* YesNo Parent A: Name* First Name Last Name Parent A: Phone Number* Parent A: E-mail* Parent A Background* Jewish by birthJewish by conversionNot Jewish Parent B: Name* First Name Last Name Parent B: Phone Number* Parent B: E-mail* Parent B Background* Jewish by birthJewish by conversionNot Jewish Primary Contact* Parent AParent BBoth Volunteer I am available to volunteer as a chaperone for local field trips, assist in special programming or have special interests or skills I would like to bring into the classroom Let us know your expectations: I want my child's Hebrew School experience to be: The best compliment is a referral. Please suggest a family that would appreciate an invite to our Hebrew school and/or Preschool and future programs. Please include Name, Address, Phone # & Email if possible 2. Children’s Information Number of children being registered* Have there been any conversions or adoptions in the family?* Please include as much information as possible. If not, write "N/A" Child 1 Is Child 1 a...* Returning StudentNew Student Full Name* First Name Last Name Hebrew Name Birth Date* Month Day Year at 123456789101112 Hour001020304050 MinutesAMPM Approximate Time of Birth for calculating Hebrew birthday* 123456789101112 Hour001020304050 MinutesAMPM School in the Fall* Grade entering in the Fall* Current Grade* Hebrew Reading Proficiency* NoneSomewhatWell Previous Jewish Education* YesNo Is your child currently receiving any services or have an Individualized Education Program (IEP)?* Write "N/A" if this does not apply Hebrew School Classes* 22 Sessions All inclusive Pricing $850 including materials and books Bat/Bar 1:1 Lessons?* $54 per lesson YesNo Sign my daughter up for the Bat Mitzvah Club* Annual cost $250 YesNo Medical Information Child 1: Does your child have any allergies (e.g., medications, foods, etc.)? Please provide details.* Please email us at [email protected] to schedule a meeting to discuss your child's allergy plan. Does your child have an EpiPen?* YesNo Are there any medical conditions we should be aware of?* Child 2 Is Child 2 a...* Returning StudentNew Student Full Name* First Name Last Name Hebrew Name Birth Date* Month Day Year at 123456789101112 Hour001020304050 MinutesAMPM Approximate Time of Birth for calculating Hebrew birthday* 123456789101112 Hour001020304050 MinutesAMPM School in the Fall* Grade entering in the Fall* Current Grade* Hebrew Reading Proficiency* NoneSomewhatWell Previous Jewish Education* YesNo Is your child currently receiving any services or have an Individualized Education Program (IEP)?* Write "N/A" if this does not apply Hebrew School Classes* Includes sibling discount ($750 per child) 22 Sessions All inclusive Pricing $650 including materials and books Bat/Bar 1:1 Lessons?* $54 per lesson YesNo Sign my daughter up for the Bat Mitzvah Club* Annual cost $250 YesNo Medical Information Child 2: Does your child have any allergies (e.g., medications, foods, etc.)? Please provide details.* Please email us at [email protected] to schedule a meeting to discuss your child's allergy plan. Does your child have an EpiPen?* YesNo Are there any medical conditions we should be aware of?* Child 3 Is Child 3 a...* Returning StudentNew Student Full Name* First Name Last Name Hebrew Name Birth Date* Month Day Year at 123456789101112 Hour001020304050 MinutesAMPM Approximate Time of Birth for calculating Hebrew birthday* 123456789101112 Hour001020304050 MinutesAMPM School in the Fall* Grade entering in the Fall* Current Grade* Hebrew Reading Proficiency* NoneSomewhatWell Previous Jewish Education* YesNo Is your child currently receiving any services or have an Individualized Education Program (IEP)?* Write "N/A" if this does not apply Hebrew School Classes* 22 Sessions All inclusive Pricing $750 including materials and books Bat/Bar 1:1 Lessons?* $54 per lesson YesNo Sign my daughter up for the Bat Mitzvah Club* Annual cost $250 YesNo Medical Information Child 3: Does your child have any allergies (e.g., medications, foods, etc.)? Please provide details.* Please email us at [email protected] to schedule a meeting to discuss your child's allergy plan. Does your child have an EpiPen?* YesNo Are there any medical conditions we should be aware of?* Child 4 Is Child 4 a...* Returning StudentNew Student Full Name* First Name Last Name Hebrew Name Birth Date* Month Day Year at 123456789101112 Hour001020304050 MinutesAMPM Approximate Time of Birth for calculating Hebrew birthday* 123456789101112 Hour001020304050 MinutesAMPM School in the Fall* Grade entering in the Fall* Current Grade* Hebrew Reading Proficiency* NoneSomewhatWell Previous Jewish Education* YesNo Is your child currently receiving any services or have an Individualized Education Program (IEP)?* Write "N/A" if this does not apply Hebrew School Classes* Includes Sibling discount ($750) 22 Sessions All inclusive Pricing $750 including materials and books Bat/Bar 1:1 Lessons?* $54 per lesson YesNo Sign my daughter up for the Bat Mitzvah Club* Annual cost $250 YesNo Medical Information Child 4: Does your child have any allergies (e.g., medications, foods, etc.)? If yes, please provide details.* Please email us at [email protected] to schedule a meeting to discuss your child's allergy plan. Does your child have an EpiPen?* If "Yes" Please email us at [email protected] to book a meeting to discuss your child’s allergy plan. YesNo Are there any medical conditions we should be aware of?* 3. Pick-Up Authorization Who is authorized to pick up your child(ren)?* Full name, contact number, relation to child Name / Number / Relation to child 4. Emergency Contacts Who should the Hebrew School team contact in an emergency if both parents cannot be reached?* Full name, contact number, relation to child Name / Number / Relation to child 5. Payment Information Payment Options* Plan A - Pay in Full (10 % Discount)Plan B - Two monthly payments (5% Discount)Plan C - 10 Auto Monthly Payments on the 5th of every month Total $0.00 *A $100 non refundable deposit, that will be applied towards tuition, will be charged to your credit card along with your form submission You have the option to pay in three installments that will be charged automatically over a three-month period. The first installment will be charged upon submission. To choose, select the 33.33% or the "Other" option above. *If you choose "Other", the remaining amount due will be split in half and charged the subsequent two months. Payment* ⚠ You have not yet connected a credit card processor.Credit Card We accept Visa, MasterCard, American Express, Discover Credit Card Number Security Code Name on Card1 - January2 - February3 - March4 - April5 - May6 - June7 - July8 - August9 - September10 - October11 - November12 - December Expiration Month2025202620272028202920302031203220332034 Expiration YearBilling Address Street Address City State / Province Postal / Zip CodePlease SelectUnited StatesAfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanThe BahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChilePeople's Republic of ChinaRepublic of ChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongoCook IslandsCosta RicaCote d'IvoireCroatiaCubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonThe GambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorthern MarianaNorwayOmanPakistanPalauPanamaPapua New GuineaParaguayPeruPhilippinesPitcairn IslandsPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint BarthelemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSomalilandSouth AfricaSouth OssetiaSpainSri LankaSudanSurinameSvalbardSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTristan da CunhaTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamBritish Virgin IslandsUS Virgin IslandsWallis and FutunaWestern SaharaYemenZambiaZimbabweOther Country 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. Here at Chabad Hebrew School, we specialize in providing an authentic Torah education to Jewish children. By policy, Bar/Bat Mitzvah service are performed for students who are considered Jewish by Israel’s Chief Rabbinate Halachic standards. Please check the box to confirm. 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. Click to Accept* I accept Terms of Enrollment E-Signature of Parent or Guardian* Date* Month Day Year Submit Should be Empty: This page uses TLS encryption to keep your data secure.
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