Chabad Community Hebrew School


 
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We are currently accepting application forms for the 2012-2013 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.

 

Enrollment Form for Chabad Hebrew School ~ 2012-2013

Student 1 Profile   Student 2 Profile

First Name

 

First Name

Last Name

 

Last Name

Hebrew Name

 

Hebrew Name

Age

 

Age

DOB   

  :    am  pm

 

DOB   

  :    am  pm

School

 

School

Grade Entering

 

Grade Entering

Hebrew Reading Proficiency
None    Somewhat     Well

 

Hebrew Reading Proficiency
None    Somewhat     Well

Previous Jewish Education
Yes             No

 

Previous Jewish Education
Yes             No

Where?

 

Where?

 

Family Information

Is the natural mother of the child Jewish? Yes No
If no, please explain.

Have there been any conversions or adoptions in the family? Yes No
If yes, please explain.


Parent Information

Father's Name

Father's Mobile

Mother's Name

Mother's Mobile

Home Phone

Address

City

Zip

Email*

* Email address allows us to communicate in the most efficient and economical manner. We do not use your address for other puropses.


Emergency Information

Emergency Contact 1

Phone

Relationship

Emergency Contact 2

Phone

Relationship

Family Physician

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

Tuition for the 2012-2013 school year is $850 per child. 10% discount for additional siblings.
Full payment plan must be submitted to the administration office before any child will be permitted to attend classes.

Complete registration and payment plan by July 31st, 2012, and pay only $825 per child!

Pay by Check (we have sent check/s in mail)

Option A: We agree to pay the full tuition of $850 (before July 31st: $825). I will be mailing a check payable to Chabad Hebrew School for the full amount to Chabad of South Dade, 3713 Main Highway, Coconut Grove, FL 33133.

Option B: We choose to pay the tuition in three installments of $300, $300,+$250. Please submit all checks (can be postdated) with the signed tuition agreement before the first day of Hebrew School.

Pay by credit card (please include payment information, below)

Option C:  We agree to pay the full tuition of $850 (before July 31st: $825) by credit card. 

Option D:  We agree to pay the tuition in 3 amounts of $300, $300 +$250 each, to be charged on September 1st, December 1st and February 1st.

Please indicate which payment option you will be choosing.(A, B, C or D)
Payment Information (for options C, D)
CC Type   CC Number
Expiration   CVN
Additional Comments (optional):      
 

Terms of Agreement

In the event of an emergency, Chabad Hebrew School has my permission to arrange for any necessary first-aid or care by a licensed physician/first-aid worker. Chabad  Hebrew School has my permission to use my child's photo in its publicity materials. I have completed the Enrollment Form and agree to pay any balance according to the terms of agreement oulined above.

I Accept   

Name:     Initials:

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

 

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Chabad Community Hebrew School 3713 Main Highway Miami, FL 33133 305-445-5444 Ext. 203

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