Final Enrollment Confirmation Form - ChabadofParkland.com

This form should only be completed after concluding the interview process and upon receipt of the acceptance email confirming your child's spot.
Child's Name *
First Name Last Name
Phone Number*
E-mail*
I would like to receive news and updates by email
Fees Due Upon Registration
Annual Activity Fee*

$150.00
*THE ANNUAL ACTIVITY FEE IS NON-REFUNDABLE AND IS NOT APPLIED TO TUITION.
Tuition Deposit *

$350.00
*THE TUITION DEPOSIT IS NON-REFUNDABLE AND IS APPLIED TO 1ST TUITION PAYMENT.
Total

$500.00

Payment*

Credit Card

We accept Visa, MasterCard, American Express, Discover
Credit Card Number	Security Code
Name on Card
Expiration Month	Expiration Year

Billing Address

Street Address

City

State / Province

Postal / Zip Code

Country

Tuition Payment Options*
Credit Card Information
Name on Card:
Credit Card Number:
Expiration Date:
Security Code:
ACH Withdrawal
Bank Name:
Name on Account:
Routing Number:
Account Number:
Type of Account:
IF YOU WOULD LIKE TO PAY FOR TUITION USING POST DATED CHECKS, YOU WILL NEED TO BRING THE 10 CHECKS BY JUNE 25TH.
Should be Empty:

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This form should only be completed after concluding the interview process and upon receipt of the acceptance email confirming your child's spot.