Kinder Registration

Kinder Registration Form

2024-2025/5785

* Thanks to an anonymous donor we are thrilled to offer free tuition for kinder students.

There is a minimal $200 fee to cover registration and book and snack fee.
Part I: Student’s Information
Child's Full Name*

First Name Last Name
Child's Hebrew Name*
*

MaleFemale
(Child’s) E-mail

Address*

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

Phone Number*

Area Code Phone Number
Day School*
Grade*
Age*
Birthday*

Month Day Year
I would like to Register an Additional Student.
2. Child's Full Name*

First Name Last Name
2. Child's Hebrew Name
2. Gender:*

MaleFemale
2. Child's E-mail
2. Day School
2. Grade*
2. Age
2. Birth Date

Month Day Year
Parents’ Information
Mother's Full Name*

First Name Last Name
Father's Full Name*

First Name Last Name
Father's E-mail*
Mother's E-mail*
Home Phone Number

Area Code Phone Number
Father's Cell Phone Number*

Area Code Phone Number
Father's Work Phone Number

Area Code Phone Number
Mother's Cell Phone Number*

Area Code Phone Number
Mother's Work Phone Number

Area Code Phone Number
Part III: Family
Brother
Birth Date

Month Day Year
Brother
Birth Date

Month Day Year
Brother
Birth Date

Month Day Year
Sister
Birth Date

Month Day Year
Sister
Birth Date

Month Day Year
Sister
Birth Date

Month Day Year
Part V: Hebrew Education
Father's Hebrew Name*
Mother's Hebrew Name*
Does your child have any learning difficulties with general studies?*

YesNo
If yes, please describe
Is the natural mother of the child Jewish?*

YesNo
Where there any conversions or adoptions in the family? *

YesNo
If yes, please explain and note which side of the family
Part VI: Medical Information
Health insurance*
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.*
Part VII: Emergency Information
Emergency Contact 1*

First Name Last Name
Contact 1 Phone Number*

Area Code Phone Number
Emergency Contact 2

First Name Last Name
Contact 2 Phone Number

Area Code Phone Number
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 Accept*

First Name Last Name
Part VIII: Payment Information
Registration Fee*

$200 - One Child$400 - Two 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: $1558 (with discount)2 Children, 4 payments: $389.503 children, full upfront: $2296 (with discount)3 children, 4 payments $574
Non-Member Pricing

1 Child, full upfront: $1070 (with discount)1 Child, 4 payments: $267.502 Children, full upfront: $2033 (with discount)2 Children, 4 payments: $508.253 children, full upfront $2996 (with discount)3 children, 4 payments $749
Total

$0.00

Yes, I'd like to donate the cost of processing this transaction by adding 3%

Payment*

Credit Card

We accept Visa, MasterCard, American Express, Discover
Credit Card Number	Security Code
Name on Card
Expiration Month	Expiration Year

Billing Address

Street Address

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 recieving the early bird discount my first payment is non-refundable.
OFFICE USE ONLY

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Part I: Student’s Information

Parents’ Information

Part III: Family

Part V: Hebrew Education

Part VI: Medical Information

Part VII: Emergency Information

Part VIII: Payment Information

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