Registration for 2016 - 2017

Click here to see the Chabad Hebrew School page

Child Information
First Name
Last Name
Hebrew Name (If known)
Date of Birth
School
Grade entering
 
Hebrew Reading Proficiency
Previous Jewish Education
Is the the Natural Mother of the child/ren Jewish? Yes No
   

Child #2 Information
First Name
Last Name
Hebrew Name (If known)
Date of Birth
School
Grade entering
 
Hebrew Reading Proficiency
Previous Jewish Education
Is the the Natural Mother of the child/ren Jewish? Yes No
   

Parent Information
Father's Name
Cell Phone
Email
Address
City
Zip Code
Mother's Name
Cell Phone
Email
Address if Different
City
Zip Code
 

Emergency Information
Emergency Contact #1
Phone Number
Emergency Contact #2
Phone Number
 

Allergies

  
Any Allergies we should be aware of? Yes No
If Yes please explain
 
I am enrolling my child/children for

Chabad HS - Sunday program - $650

Chabad HS - Sunday & Tuesday program - $950

I/we give permission for my child/ren to to attend all field trips and outings that are part of the Chabad Hebrew School.

I/we grant permission for my child to have their photo/image and name published by Chabad.

As the parent(s) or legal guardian(s) of the above entered student, I/we authorize any adult acting on behalf of the Chabad Hebrew School to hospitalize or secure treatment for my child/ren. I further agree to pay for all charges for that care and/or treatment. It is understood that if time and circumstances reasonably permit, The Chabad Hebrew School will try to communicate with me prior to such treatment.

Payment Options
Payment Options

One payment of $700/$1,000 ($50 discount before July 15)

Please contact me to arrange a payment plan

visa.gifmc.gifamex.jpgCheck

Please make all checks out to Chabad of the Main Line. Our address is 625 Montgomery Ave. Merion Station PA 19066

Name on Card
Card Number
Amount
Exp. Date /
CCV