How many students are you registering?
1 Student
2 Students
3 Students
4 Students
Student Profile 1
Full Name
Hebrew Name
Date of Birth
School attending
Grade Entering
Please select
Kindergarten
First
Second
Third
Fourth
Fifth
Sixth
Seventh
Hebrew Reading Proficiency
Please select
None
Somewhat
Well
Previous Jewish Education
Yes
No
Where?
Is the natural mother of the child born Jewish?
Yes
No
Have there been any conversions or adoptions in the family?
Yes
No
Student Profile 2
Full Name
Hebrew Name
Date of Birth
School attending
Grade Entering
Please select
Kindergarten
First
Second
Third
Fourth
Fifth
Sixth
Seventh
Hebrew Reading Proficiency
Please select
None
Somewhat
Well
Previous Jewish Education
Yes
No
Where?
Is the natural mother of the child born Jewish?
Yes
No
Have there been any conversions or adoptions in the family?
Yes
No
Student Profile 3
Full Name
Hebrew Name
Date of Birth
School attending
Grade Entering
Please select
Kindergarten
First
Second
Third
Fourth
Fifth
Sixth
Seventh
Hebrew Reading Proficiency
Please select
None
Somewhat
Well
Previous Jewish Education
Yes
No
Where?
Is the natural mother of the child born Jewish?
Yes
No
Have there been any conversions or adoptions in the family?
Yes
No
Student Profile 4
Full Name
Hebrew Name
Date of Birth
School attending
Grade Entering
Please select
Kindergarten
First
Second
Third
Fourth
Fifth
Sixth
Seventh
Hebrew Reading Proficiency
Please select
None
Somewhat
Well
Previous Jewish Education
Yes
No
Where?
Is the natural mother of the child born Jewish?
Yes
No
Have there been any conversions or adoptions in the family?
Yes
No
Parent Information
Father's Name
Father's Phone
Father's Email
Mother's Name
Mother's Phone
Address
City
State
Zip
Emergency Information
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 - $950 annual tuition
The following is a tuition agreement for the Chabad of Chatsworth Hebrew School. The agreement explains the tuition fees, payments plans and refund policies. Please read it through carefully. If paying by check or cash, full payment must be submitted to the school office before any child will be permitted to attend classes. The tuition for the Chabad of Chatsworth Hebrew School is $950 Please note that all tuition agreements are annual and not based on a monthly basis *All credit card charges are subject to a 3% processing fee*
Plan A: Pay the entire amount in full with a check, cash or credit card.
Plan B: Pay the annual tuition on a monthly basis by submitting 9 checks at the beginning of Hebrew School
Plan C: Pay the tuition on a monthly basis with a credit card. Your credit card will be billed monthly from September through May. To do so please include your credit card information below.
Credit Card Information
Type
Visa
MC
Amex
Discover
Number
Expiration
Code
Use contact info above
Name
Address
Zip
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 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!
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