Printed from ChabadSilverSpring.com

Hebrew School Registration 2016/2017

Hebrew School Registration 2016/2017

We are currently accepting application forms for the 2016-2017 school year. Please fill out ALL fields of this form. If you have any questions or concerns you'd like to discuss with us, feel free to call our director Chaya Wolvovsky at 301-593-1117 or email silverspringchabad@gmail.com.

If you would prefer to fill out this paper and mail it into our office, a fillable PDF can be found here.

Please note that one registration form per child is needed.

 

Student Profile
 
Last Name
First Name
Hebrew Name
Age
DOB
School
Grade Entering
Hebrew Reading Proficiency None Somewhat Well
Previous Jewish Education Yes No
Where?

 

Parent Information
 
Address
City/Zip
Phone
Father's Name
Father's Occupation
Father's Cell
Father's Email
Mother's Name
Mother's Occupation
Mother born Jewish? Converted by whom?
Mother's Cell
Mother's Email

 

Emergency Information
 
Emergency Contact 1
Phone
Emergency Contact 2
Phone
Doctor's Name
Doctor's Phone Number
Medical Insurance Company
Policy Number

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.



Registration Payment Agreement
Tuition for the year, per child: $800
 

Method of Registration payment:

Credit Card (form below)
Check (Please mail checks to Chabad Hebrew School )

Family Name  
Child 1 $800 Tuition
Child 2 $800 Tuition
Child 3 $800 Tuition
Total Registration Cost:  
Registration Payment
Refer a friend and save an additional 10%! (Friend must be new to CHS and will be registering their child for CHS this coming year)
  Name of Friend
CC Type   Card Number
Billing Address   City, State, Zip
CVV   Exp Date

Total Registration charges:$

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: Date:

We look forward to a wonderful year of learning and growth!

 

 

Secure This page uses 128 bit SSL encryption to keep your data secure.