Chabad Hebrew School

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Chabad Hebrew School

Chabad Hebrew School is an innovative school that provides a serious yet enjoyable environment in which children receive a broad Jewish education in a stimulating and challenging setting.
Our students gain an appreciation for the joys, values and traditions of our heritage vividly brought to life by our dedicated teachers. Their creativity and dynamism make every lesson a unique learning experience.

Click Here to read more about our Hebrew School

Register today to ensure a Jewish tomorrow. Please complete the form below. If you have any questions, feel free to contact our Hebrew School principal, Rochel Carlebach, who will be happy to discuss your child with you! 732-858-1770 or rochel@chabadholmdel.com to email.

Please note that one registration form per child is needed.

________________________________________________________________________________

STUDENT INFORMATION
Family Name		Is the natural mother of the child Jewish? Yes No Were there any conversions or adoptions in the child's family? Yes No - If yes, please explain Has your child had any previous Hebrew Education? Yes No --- If yes, where? Does your child read basic Hebrew? Yes No
First Name
Hebrew Name
Date of Birth
Age	Sex Grade
School Attending
Home Address
City, State, Zip

PARENT INFORMATION
*Father*		*Mother*
Father's Name		Mother's Name
Hebrew Name		Hebrew Name
Date of Birth	/ / MM / DD / YYYY format	Date of Birth	/ / MM / DD / YYYY format
Home Tel.		Home Tel.
Work Tel.		Work Tel.
Cell #:		Cell #:
Occupation		Occupation
Email		Email

MEDICAL INFORMATION
Persons to be contacted in case of an emergency when parents cannot be reached (Please provide 2 contacts)
Name	Phone	Relationship to Child
Name	Phone	Relationship to Child
In an emergency, when you cannot reach either parent, I authorize the school to call: Family Physician Phone
I hereby consent to the administration of the Chabad Hebrew School to take whatever medical measures they deem necessary for my child in the even of a medical emergency. Parent/Legal Guardian Initials

TUITION AGREEMENT
The following document is a tuition agreement for the Chabad Hebrew School. The agreement explains the tuition fees, payments plans and refund policies. Please read it through carefully and sign it on the signature line below. The signed tuition agreement along with full payment must be submitted to the school office before any child will be permitted to attend classes. Refunds for children withdrawing from school before the end of the school year will be granted provided that the school office is given 30 days written notice. Tuition refunds will not be granted to children withdrawing from school after April 1st. A limited number of scholarships are available upon request; no child will be turned away for lack of funds.
PLEASE CHOOSE ON OF THE FOLLOWING TUITION OPTIONS: Pay full tuition of $550.00 by credit card below.
Divide my payments into 2 charges of $275.00
	2 postdated checks - Dated 9/1/13 and 2/1/14 Due by first day of School. 2 credit card payments - Charged on 9/1/13 and 2/1/14.

PAYMENT INFO
Amount to be charged:
Please charge my:
Card #:
Exp. Date
Cvv Code:
Optional Comments:

*Type the code you see in the picture below.(Letters are not case-sensitive)