CTeen 2012-13
Online Registration Form

We are now accepting registrations 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.

 

Please use one registration form per participant.

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

   

Student Profile
First Name
Last Name
Hebrew Name
DOB            
Gender Male            Female
School Attending
Grade Entering
Hebrew Reading Proficiency None    Somewhat    Well
Hebrew Speaking Proficiency None    Somewhat    Well
Previous Jewish Education/Hebrew School Yes            No
If yes, please describe
Synagogue afiliation
Natural mother of child Jewish? Yes            No
Conversions / adoptions in family? Yes            No
If yes, please describe
Any considerations, such as learning disorder or difficulty, the school should be aware of? (Confidential):


Parent Information
Father's Name
Father Home Phone
Father Work Phone
Father Cell Phone
Father Email
Mother's Name
Mother Home Phone
Mother Work Phone
Mother Cell Phone
Mother Email
Address
City
Province
Postal Code
Spouse Address (if different):

Emergency Information
Emergency Contact 1
Relationship to child
Home Phone
Cell 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. 



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:

 

Payment Plan

This page uses a secure connection and your information remains confidential.

Annual tuition: $500 (registration and book fee included) 

 

Tuition Agreement

The following is a tuition agreement. The agreement explains the tuition fees, payments plans and refund policies. Please read it through carefully. If paying by check or cash, full payment must be submitted to the school office before any child will be permitted to attend classes.

The tuition is $500.00 per year per child (this includes a registration & book fee).

Discounts: There is a 10% discount off of the regular tuition for each additional child of the same family. There is a 10% additional discount off your total tuition for each child of another family you successfully introduce to the Chabad Hebrew School.

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:You may pay the annual tuition in two payments of $250 each. First payment in Septmeber and the second in January. Payment can be made by check or credit card. Checks must be submitted before the first day of Program
PLAN C: You may pay the annual tuition on a monthly basis on your credit card or by submitting 10 checks of $50.00 each, dated September through June. All checks must be submitted before the first day of Program.

 
Accept  Do Not Accept
Your FULL name here:  


Amount: $
Card Number
Last Name
Address
City
Province
Postal Code
Card Type
Exp. Date  
CW#


I heard about Chabad's Programs from:

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