Quick and Easy Registration for Returning Students

Quick and Easy Registration for Returning Students

Hebrew School 2022/23- 5783

(Do you know of a new family looking for a Hebrew School? Refer them to Chabad and receive a $100 tuition credit)

*Registration received after August 1st incur a late fee of $75
Number of Returning Children Being Registered*
Children's Information:
Child 1:*

First Name Last Name
Grade Entering as of Sept. 2022:*
Birth Date*

Month Day Year
Tuition:* Plan A: Pay in Full Plan B: Pay in Installments
To view and fill out the Chai Club partnership form, click here .
Does your child have an IEP? If yes, please email it in.*

Yes No
Track Selection: (choosing this track does not bind you for the entire year. You can choose a different track if your comfort level changes)

In Person Virtual Pods (create your own - 5 or more children, parents are responsible to form their own pods of similar ages)
Allergies: If any, please list.
Child 2:

First Name Last Name
Grade Entering as of Sept. 2022:
Birth Date

Month Day Year
Does your child have an IEP? If yes, please email it in.

Yes No
Child 2 Track Selection: (choosing this track does not bind you for the entire year. You can choose a different track if your comfort level changes)

In Person Virtual Pods (create your own - 5 or more children, parents are responsible to form their own pods of similar ages)
Allergies: If any, please list.
Tuition: Plan A: Pay in Full Plan B: Pay in Installments
Child 3:

First Name Last Name
Grade Entering as of Sept. 2022:
Birth Date

Month Day Year
Does your child have an IEP? If yes, please email it in.

Yes No
Child 3 Track Selection: (choosing this track does not bind you for the entire year. You can choose a different track if your comfort level changes)

In Person Virtual Pods (create your own - 5 or more children, parents are responsible to form their own pods of similar ages)
Allergies: If any, please list.
Tuition: Plan A: Pay in Full Plan B: Pay in Installments
I would like to contribute towards the scholarship fund for children who cannot afford full tuition:

$36 $72 $180 $400
I would like to sponsor the education of another child for $1591
Payment Information:
Parent 1 Name:*

First Name Last Name
E-mail*

Address*

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

Parent 2 Name:

First Name Last Name
E-mail
Address is:

Same as above. Different.

Address

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

Please indicate any changes to your personal/contact information that has changed since last year:
Late Fee

$75
Total:

$0.00

Payment

Credit Card

Credit Card Type
Credit Card Number	Security Code
Name on Card
Expiration Month	Expiration Year

Billing Address

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Country

Should be Empty:

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Children's Information:

Payment Information:

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