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Student Registration

Student Registration:
If your child is entering the Kindergarten class please fill out the complete form and skip the payment information. Thank you
Student #1 Profile
Full Name:*
First NameLast Name
Hebrew Name:*
Age:*
Birth Date:*
MonthDayYear
Gender:*
MaleFemale
Does your child have an IEP? If yes, please email it in.*
YesNo
Grade Entering:*
Tuition:*Plan A: Pay in Full
Plan B: Pay in Installments
To view and fill out the Chai Club partnership form, click here.
Student #2 Profile
Full Name:
First NameLast Name
Hebrew Name:
Age:
Birth Date:
MonthDayYear
Gender:
MaleFemale
Does your child have an IEP? If yes, please email it in.
YesNo
Grade Entering:
Tuition:Plan A: Pay in Full
Plan B: Pay in Installments
Student #3 Profile
Full Name:
First NameLast Name
Hebrew Name:
Age:
Birth Date:
MonthDayYear
Grade Entering:
Gender:
MaleFemale
Does your child have an IEP? If yes, please email it in.
YesNo
Tuition:Plan A: Pay in Full
Plan B: Pay in Installments
Payment Information:

Address:*

Work Address:*

Work Address:*

Mother's Cell Phone Number:*
Area CodePhone Number
Mother's E-mail Address:*
Is the biological mother Jewish?*
YesNo
Any Conversions in the family?*
YesNo
If yes, please provide details:
Grandparents Information (for Nachas reports):
We would love to send updates about your child to their grandparents throughout the year.
Paternal
Full Name:
First NameLast Name

Address:

Address:

Home Address:

Home Phone Number:
Area CodePhone Number
Work/Cell/Pager Number:
Area CodePhone Number
Physicians Name:
First NameLast Name
Physicians Phone Number:
Area CodePhone Number
Medical Insurance Company:
Group #:
ID #:
*
As the parent(s) or legal guardian of , I/we authorize any adult acting on behalf of Chabad of the Rivertowns 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.
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:
To view and fill out a tuition assistance form, Click here.
I would like to sponsor the education of another child for $1491
I would like to contribute toward the Jewish education of another child:
$36$72$180$360
Total:
$0.00

Payment:

Credit Card Check

Postal / Zip Code

Country

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Student Registration: