Please fill out ALL fields of this form (one for each child).  If you have any questions or concerns, please contact us.  Children should be 8 - 13 years old.  Stay tuned for 2018-2019 dates.

Student Profile
 
Name
Last
Hebrew Name
DOB
School
Grade Entering
Hebrew Reading Proficiency None Somewhat Well
Previous Jewish Education Yes No
Where?
Parent Information
 
Father's Name
Father Jewish?
Any Conversion?
Phone
Mother's Name
Mother Jewish?
Any Conversion?
Phone
Address
City
State
Zip
Email Address
Emergency Information
 
Emergency Contact 1
Phone
Emergency Contact 2
Phone

 

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.



Tuition Agreement

The cost for Hebrew School is $950/per child for the year which includes book, supplies, and registration fees. In addition, a synagogue membership is required.

You may choose from the following payment methods:
PLAN A: You may pay the entire amount in full with a check, cash, or credit card.
PLAN B: Pay in two payments: Sept 1st and Jan 1st
   
Please contact the office at 973-895-3070 to discuss any financial considerations.
Credit Card Information
Credit Card Number Billing Address
City State, Zip
Charge Amount Exp Date
CVV    

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.

I Accept

Name: Initials:

We look forward to a wonderful year of learning and growth!