Returning Student Registration

Hebrew School Registration - Payment Plans
Plan A: Pay full tuition upfront ($30 discount).
Plan B: Pay in 4 installments by automatically charging credit card
If this coming year will be the first time your child is joining us for Hebrew School please fill out our new student form here .
Parent's Full Name*
First NameLast Name
Child 1 Full Name*
First NameLast Name
Child's Hebrew Name*
Grade Entering as of 9/21*
Child 2 Full Name
First NameLast Name
Child's Hebrew Name
Grade Entering as of 9/22
Child 3 Full Name
First NameLast Name
Child's Hebrew Name
Grade Entering as of 9/22
Emergency Information
(new addition to all registrations)
Emergency Contact 1*
First NameLast Name
Contact 1 Phone Number*
Area CodePhone Number
Emergency Contact 2
First NameLast Name
Contact 2 Phone Number
Area CodePhone Number
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 the 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, the 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 trips on and beyond school properties and allow my child to be photographed while participating in the Chabad Hebrew School activities and that these pictures may be used for marketing purposes.
I agree to the above:*
First NameLast Name
DISCOUNTED PRICING FOR 2022/2023
Information and Payment
Members:  $850/ year
Non-Members:  $1100/ year
Family Discount:  10% off each additional child
Tuition Paid in Full $30 Discount per child
Registration fee regularly $75 per child
Registration Fee$75/ Child registering
$75 - One Child$150 - Two Children$225 - Three Children
Please select:*
Member: 1 child: payment in full $820Member: 1 child: 4 payments $205*Member: 2 children: payment in full $1558 (with 10% discount on second registration)Member: 2 children: 4 payments $389.50*Member: 3 children: payment in full $2296 (with 10% discount on second and third registration)Member: 3 children: 4 payments $574*Non Member pricing: 1 child: payment in full $1070Non Member pricing: 1 child: 4 payments $267.50*Non Member pricing: 2 children: payment in full $2033 (with 10% discount on second registration)Non Member pricing: 2 children: 4 payments $508.25*Non Member pricing: 3 children: payment in full $2996 (with 10% discount on second and third registration)Non Member pricing: 3 children: 4 payments $749*
Member Pricing
1 Child, full upfront: $820 (with discount)1 child: 4 payments $2052 Children, full upfront: $1585 (with discount)2 children: 4 payments $389.503 children: payment in full $2296 (with 10% discount on second and third registration)3 children: 4 payments $574
Non-Member Pricing
1 Child, full upfront: $1070 (with discount)1 child: 4 payments $267.502 children: payment in full $2033 (with discount)2 children: 4 payments $508.253 children: payment in full $2996 (with discount)3 children: 4 payments $749
Total
$0.00
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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

Questions/Comments:
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 trips on and beyond school properties and allow my child to be photographed while participating in Chabad Hebrew School activities and that these pictures may be used for marketing purposes. If for any reason you decide to cancel during the year, you will be refunded/ not charged from the beginning of the next month. There are no refunds after May 1st. I understand that by receiving the early bird discount my first payment is non-refundable.
Name*
Date*
FOR OFFICE USE ONLY
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Emergency Information

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