New Student/s Registration

Registration is now open for Hebrew School year 2019/20
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.
We look forward to a wonderful year of learning and growth
Student Information
Full Name
First NameLast Name
Child 1
Hebrew Name
Gender
FemaleMale
Birth Date
MonthDayYear
School
Grade Entering
Hebrew Reading Proficiency
NoneSomewhatWell
Previous Jewish Education
YesNo
Where?
Medical information - Any Medical challenges?
YesNo
If yes, please explain
Parent Information
Father's Full Name
First NameLast Name
Phone Number
Area CodePhone Number
Father's E-mail
Mother's Full Name
First NameLast Name
Phone Number
Area CodePhone Number
Mother's E-mail

Address

Home Phone Number
Area CodePhone Number
Is the biological mother of the child(ren) Jewish?
YesNo
Have there been any adoptions or conversions in the family (e.g., the child, parents, grandparents)
YesNo
if yes, who was the Rabbi?
Emergency Contact
Full Name
First NameLast Name
Phone Number
Area CodePhone Number
Relation to child
Pick up from school and drop off at home
We love to make things easier for parents!
We offer pick up from all downtown schools and we also offer drop off at home.
One way: $125
Both ways: $200
We will contact you to make proper arrangements
Pick up options
From schoolBack homeBoth ways
Tuition
Classes are held Tuesday Afternoons
Preschool Tots - 2's and 3's: 4:00 - 5:15
Full Year: $1300
2nd Semester: $650
Pre K - Grade 6: 4:00 - 6:00 (we offer supervised play from 3:00 - 4:00)
Full Year $1500
2nd Semester: $750
Grade 7 - Bar & Bat Mitzvah Class: 4:00 - 6:00
$1500
Discount: There is a 10% discount off of the regular tuition for each additional child of the same family. There is a 5% additional discount off your total tuition for each child of another family you successfully introduce to the Chabad Hebrew School.
I am registering for
One childTwo childrenThree children
Select Payment Plan
Pay in fullThree paymentsOther - call to discuss
Total Amount to be charged today
$

Payment

Credit Card

Billing Address

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Country

Terms of Agreement
In the event of an emergency, Chabad BPC Hebrew School has my permission to arrange for any necessary first-aid or care by a licensed physician/first-aid worker. Chabad BPC 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 outlined above.
I agree
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Student Information