Registration for Previously Enrolled Students
2016-2017
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Child Information
First Name
Last Name
Hebrew Name (If known)
Date of Birth
School
Grade entering
Updated Address, Phone Number or Email

Child #2 Information
First Name
Last Name
Hebrew Name (If known)
Date of Birth
School
Grade entering
Allergies:
Enrollment
I am enrolling my child/children for

Chabad HS - Sunday program - $700

Chabad HS - Sunday & Tuesday program - $1,000

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/$950

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