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Hebrew School Registration form

Hebrew School Registration form

REGISTRATION FORM 2017-2018

For Children 5 - 13

Sundays from 9:30 - 11:30


Child Information (if enrolling more than one child please copy and complete child information).

Last name..................................... First Name .........................................

Hebrew Name ............................. D.O.B. ....../....../...... Entering Grade (Fall 2017) .............


My Child: (check one) Does not read Hebrew....... Recognizes letters of the Alef-Bet......

Can read Hebrew slowly...... Can read Hebrew very well......

Does your child have any special learning or behavioral needs? ...........................................

......................................................................................................................................

Any pertinent health information or Allergy? .........................................................................

......................................................................................................................................
_____________________________________________________________________________

Family Information

Are the natural mother, maternal grandmother and father Jewish? Yes.......... No ...........

If no, please explain .......................................................................................................

.....................................................................................................................................

Have there been any conversions or adoptions in your family? Yes .......... No ..........

If yes, please explain .....................................................................................................

....................................................................................................................................
___________________________________________________________________________

Parent Information

Address ......................................................................................................................

City ................................................................................... Zip.................

Father Mother

First Name: .............................................. ...............................................................

Cell Phone: ............................................. ...............................................................

Home Phone: ............................................ ...............................................................

E-mail: .................................................... ................................................................

Emergency Contact

Name and relationship: ................................................................................................

Phone: ..............................................................................

In the event of an emergency, the Chabad Hebrew School has my permission to arrange
for any necessary first-aid or care for my child. I give permission for my child/ren to take class trips with the Chabad Hebrew School. I hereby hold harmless and release Chabad Hebrew School and its representatives from any liability regarding thereto. I take responsibility for any damage caused by my child/ren at the Hebrew School facility. I allow photos of my family to be used for any legitimate use.
I agree to pay the balance or make payment arrangements before the beginning of the school year for $500.00 + $50.00 (Registration and Book Fee) for a total of $550.00.
__________________________________________________________________________

Payment Options:
Make check payable to "Chabad of Peachtree City/ Hebrew school”

_____ I am mailing One check for payment in full $550.00.or

_____ I am mailing one check for $500 (with early registration)


_____Ten postdated checks $55.00 or

Credit Card Information:

Credit Card number: .................................................................. Expiration: .............................

______Amount in full $550.00 or_____ in ten month $55.00

______ Amount in full $500.00 ______ in ten months $50.00


Signature of parent or legal guardian ....................

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