Chabad Returning Hebrew School Registration

Chabad Hebrew School, Where Jewish Pride Comes Alive!

New or Returning Student(s)

New

Returning

Parent Information

I am donating as a...

Parent 1 First Name

Parent 1 Last Name

Parent 1 Phone Number

Parent 1 Email Address

Parent 2 First Name

Parent 2 Last Name

Parent 2 Phone Number

Parent 2 Email Address

Street Address

Unit or Apartment Number

City

State or Province

Postal Code

Country

Yes, I would like to receive email communications.

Student Information

How many students are you enrolling?

Student 1 Information

First Name

Last Name

Hebrew Name

Age

Birthday

Current School

Grade Entering

Are there any considerations, such as a learning disability or classroom difficulty, that the school should be aware of?

Yes

No

Please Explain

Is your child currently taking any medication?

Yes

No

Please Explain

Does your child read basic Hebrew?

None

Somewhat

Well

Does your child have previous Jewish Education

Yes

No

If yes, please describe:

Does your child have any allergies?

Yes

No

What is your child allergic to?

Student 2 Information

First Name

Last Name

Hebrew Name

Age

Birthday

Current School

Grade Entering

Are there any considerations, such as a learning disability or classroom difficulty, that the school

Yes

No

Please Explain

Is your child currently taking any medication?

Yes

No

Please Explain

Does your child read basic Hebrew?

None

Somewhat

Well

Does your child have previous Jewish Education

Yes

No

If yes, please describe:

Does your child have any allergies?

Yes

No

What is your child allergic to?

Student 3 Information

First Name

Last Name

Hebrew Name

Age

Birthday

Current School

Grade Entering

Are there any considerations, such as a learning disability or classroom difficulty, that the school should be aware of?

Yes

No

Please Explain

Is your child currently taking any medication?

Yes

No

Please Explain

Does your child read basic Hebrew?

None

Somewhat

Well

Does your child have previous Jewish Education

Yes

No

If yes, please describe:

Does your child have any allergies?

Yes

No

What is your child allergic to?

Student 4 Information

First Name

Last Name

Hebrew Name

Age

Birthday

Current School

Grade Entering

Are there any considerations, such as a learning disability or classroom difficulty, that the school should be aware of?

Yes

No

Please Explain

Is your child currently taking any medication?

Yes

No

Please Explain

Does your child read basic Hebrew?

None

Somewhat

Well

Does your child have previous Jewish Education

Yes

No

If yes, please describe:

Does your child have any allergies?

Yes

No

What is your child allergic to?

Emergency Contact Information

Full Name

Phone Number

Relationship to Child

Consent Questions

I hereby give consent to the administration of the Chabad Hebrew School to take whatever medical measures they deem necessary, at my expense, for my child in the event of a medical emergency

I Agree

Photo Release

I give permission to use pictures of my children in public settings like Chabad's website, advertising and marketing materials

I Agree

I Do Not Agree

Chabad Hebrew School Tuition

Choose how you would like to pay:

$

I would like to add Wednesday Night Hebrew School in Bexley to my registration ($500)

Payment Info

Credit Card

Bank Account

PayPal

Donor Advised Fund

OneClick

Card Number

Expiration Date

Name On Card

CVV Code

Account Number

Routing Number

Name On Account

Account Type

Checking

Savings

Billing Street Address

Billing Unit or Apartment Number

Billing City

Billing State or Province

Billing Postal Code

Billing Country

Hidden Student Names

hiddenStudentNames

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