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JUDA-Hebrew School of the Arts

Inspiring Jewish Pride and Identity in Jewish Children - the future of Judaism.

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Registration Form

Child 1 Information
Child's Name*

First Name Middle Name Last Name
Child's Hebrew Name*
Birth Date*

Month Day Year
School*
Grade entering (fall 2022)*
Previous Jewish Education
Child 2 Information
Child's Name

First Name Middle Name Last Name
Child's Hebrew Name
Birth Date

Month Day Year
School
Grade entering (fall 2022)
Previous Jewish Education
Child 3 Information
Child's Name

First Name Middle Name Last Name
Child's Hebrew Name
Birth Date

Month Day Year
School
Grade entering (fall 2022)
Previous Jewish Education
Parents' Information
Father's name*

First Name Last Name
Father's email*
Father's Cellphone*

Area Code Phone Number
Mother's name*

First Name Last Name
Mother's email*
Mother's Cellphone*

Area Code Phone Number

Address*

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

Religious History
Were there any conversions in the family?*
If yes, what is the relation to the student?
Where was the conversion done?
Who performed the conversion?
Emergency Information
Emergency contact 1*

First Name Last Name
Phone Number*

Area Code Phone Number
Emergency contact 2

First Name Last Name
Phone Number

Area Code Phone Number
Medical Information (confidential)
Up to date with vaccinations*

yes no
Date of last tetanus shot*

Month Day Year
Additional medical concerns
As the parent(s) or legal guardian of the above child, 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, 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
Payment
In an effort to keep our Hebrew School fees the lowest in the area we are requesting that all fees be paid at the beginning of the school year, as in prior years. This enables us to save on administrative, stationary, mailing & etc. costs. We can also plan our budget more effectively.

You may pay your balance in one sum or submit postdated checks, dated up until April 1, 2023. A credit card can be submitted as well and we can charge it in monthly installments if needed(a Credit Card 2.9 % surcharge will apply) . No refunds or credits will be made due to absenteeism.

If you have difficulty with the above, please call our office to coordinate other arrangements.
Registering:*

One Child $1199 - Payment in Full Two Children - $1199 + $1099 - Payment in full Three Children - $1199 + $1099 + $1069 - Payment in full One Child - Paying deposit now ($400) Two Children - Paying deposit now ($800) Three Children - Paying deposit now ($1200)
Chabad Family Membership (optional)

$995
Total

$0.00

Yes, I'd like to donate the cost of processing this transaction by adding 2.9%

Payment

Credit Card Check or cash

Postal / Zip Code

Country

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