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Hebrew Enrichment Registration Form

Hebrew Enrichment Registration Form

  Student Information

   
     Male Female
Does your child have previous Jewish Education Yes No
If yes, please describe:

 

What school does your child attend?  Grade entering:   
 

Any considerations, such as learning disorder or difficulty, the school should be aware of? (Confidential):

 Parent Information
   
   
 
  

   
  

  
 

 Emergency Contact Information
Please list two contacts to be used in case of emergencies (other than your home and business numbers).
 
   

 
   

 
   
 

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

 

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 trip on and beyond school properties and allow my child to be photographed while participating in Chabad Hebrew School activities.
Accept  Do Not Accept
Initial here:  


Hebrew Enrichment Class Tuition Agreement

The following is a tuition agreement for the Hebrew Enrichment Class Program. The agreement explains the tuition fees, payments plans and refund policies. Please read it through carefully. If paying by check or cash, full payment must be submitted to the office before any child will be permitted to attend classes.

The tuition for the Hebrew Enrichment Class is: 

1st Session: $144 (12 Classes)

Please check our class calendar with your teacher for holidays and school vacations.

There will be no refund for missing classes on a non vacation days, the teacher will make a copy of all class and home work materials for the student and will be happy to assist him/her with any question over the phone or email.


If you would like to set up an auto payment plan please enter the following information: 

 Amount       


Card Number:  

Expiration Date     

CVV Security Code


  Accept  Do Not Accept


Your FULL name here: 

  Notes: 
 

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