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Chabad Hebrew School

Inspiring Jewish Pride and Identity in Jewish Children - the future of Judaism.

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Registration Form

We are currently accepting application forms for the 2020-2021 school year. Please fill out ALL fields of this form. If you have any questions or concerns you'd like to discuss with us, please contact us at 310.544.5544

Please note that one registration form per child is needed.

We look forward to a wonderful year of learning and growth.
STUDENT PROFILE
Students Name*

First Name Last Name
Hebrew Name If known
Date of Birth*

Month Day Year
Gender*

Boy Girl
Grade Entering*
Previous Jewish Education*

Yes No
PARENTS INFORMATION
Father Name

First Name Last Name
Jewish by birth* Fathers Jewish Status

Yes No
Father Phone

Area Code Phone Number
Father E-mail
Mothers Name

First Name Last Name
Jewish by birth* Mothers Jewish Status

Yes No
Mother Phone

Area Code Phone Number
Mother E-mail

Address

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

EMERGENCY CONTACT
1 Emergency Contact*

First Name Last Name
Phone*

Area Code Phone Number
Relation to Child*
2 Emergency Contact

First Name Last Name
Phone

Area Code Phone Number
Relation to Child
PAYMENT
The Tuition fee is $800 for the year. There are two payment options.
1. A full payment of $800
2. Four installments of $200

Payments can be made by Credit Card or by Check. If you need financial assistance please choose "Financial Assistance Requested" and we will contact you regarding any scholarship opportunities
Payment Options

Charge my CC Full amount Charge my CC in 4 Installments I'm paying the Deposit Financial Assitance Needed
Total

$100.00

Payment

Credit Card Check

Postal / Zip Code

Country

Should be Empty:

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