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Application Form
Hebrew School for the 2022-2023 year will be Tuesdays 3:30-5:30. A Sunday option may be available if there is enough interest, contact Chyena for details.

Returning Families: Your child's place in our school is guaranteed if registered by July 30, 2022

New Hebrew School families: You may fill out this application form and we will contact you in August to let you know if we have room to accept. We will also set up a meeting with Rabbi Nochum & Chyena prior to acceptance in Hebrew School.
Child #1 Information
Full Name*

First Name Last Name
Hebrew Name
Entering Grade*
Date of Birth*

Month Day Year
My Child*

Does Not Read Hebrew Recognizes letters of the Alef-Bet Can read Hebrew slowly Can read Hebrew very well Can speak Hebrew
My Child’s knowledge of basic Judaism*

Good Fair Very minimal
Does your child have any allergies?
Would you like to register another child?

Yes No
Child #2 Information
Full Name

First Name Last Name
Hebrew Name
Entering Grade
Date of Birth

Month Day Year
My Child

Does Not Read Hebrew Recognizes letters of the Alef-Bet Can read Hebrew slowly Can read Hebrew very well Can speak Hebrew
My Child’s knowledge of basic Judaism

Good Fair Very minimal
Does your child have any allergies?
Family Information
Is the child's biological mother born to a Jewish mother?*

Yes No
Is the child's biological father born to a Jewish mother?*

Yes No
Have there been any conversions or adoptions in your family?*

Yes No
If yes, please explain
Address and Information

Address*

Home Phone

Area Code Phone Number
Parents
Father
Full Name*

First Name Last Name
Occupation*
E-mail*
Cell Number*

Area Code Phone Number
Mother
Full Name*

First Name Last Name
Occupation*
E-mail*
Cell Number*

Area Code Phone Number
Emergency Contact

In case of emergency and the parents cannot be contacted please contact
Full Name*

First Name Last Name
Phone Number*

Area Code Phone Number
More Information
What is your main reason for choosing to send your child/ren to Chabad Hebrew School?*
How / from whom did you hear about Chabad Hebrew School?
Payment Information
Limited Scholarships Available. Please contact Chyena for more information.

$595 base price for the year (26-30 weeks). This includes registration fee, book fee, snacks, and all associated fees.

Discounts:
Choose 1 discount per child.
$50 discount for registering by July 30
$100 discount for new students (first year of Hebrew School)
$50 sibling discount (off second child's tuition)

Contact Chyena to arrange a payment plan if necessary.
A minimum deposit of $100 is necessary to confirm placement. Deposit will be refunded if we do not have room to accept your child.
Tuition Total*

$
Total Charged Now

$0.00

I would like to pay today: Full amount $100.00 minimum $

Yes, I'd like to donate the cost of processing this transaction by adding 3%
If partial payment was selected, how do you prefer to pay the rest? Cash/Check/Venmo/Credit Card Payment Plan etc.

Payment

Credit Card Paypal

Postal / Zip Code

Country

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Application Form