HEBREW SCHOOL REGISTRATION FORM

CLICK HERE IF YOUR CHILDREN ARE RETURNING STUDENTS

We are currently accepting application forms for the 2018-2019 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. You may call 954-600-6991 and speak with Rabbi Gutnick or Ilene. We look forward to a wonderful an year of Jewish education for your child.

STUDENT INFORMATION
First Name   Last Name
Hebrew Name   D.O.B.
School   Grade Entering
Hebrew Reading Proficiency None Somewhat Well
Previous Jewish Education Yes No If yes - where?
STUDENT INFORMATION (IN CASE OF SECOND CHILD)
First Name   Last Name
Hebrew Name   D.O.B.
School   Grade Entering
Hebrew Reading Proficiency None Somewhat Well
Previous Jewish Education Yes No If yes - where?
STUDENT INFORMATION (IN CASE OF THIRD CHILD)
First Name   Last Name
Hebrew Name   D.O.B.
School   Grade Entering
Hebrew Reading Proficiency None Somewhat Well
Previous Jewish Education

Yes No If yes - where?

PARENT INFORMATION
Father's Name   Father's Cell
Mother's Name   Mother's Cell
Address   Mother Email
Home Phone   Father Email
Were there any conversions in the family? Yes No
If yes, please specify:
EMERGENCY INFORMATION
Emergency Contact   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 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:
Date:

PAYMENT SCHEDULE & OPTIONS

 

Your form is not complete without a payment plan.


Tuition Rate  

 

(In case of) 2nd Child  

 

(In case of) 3rd Child 

 

These fees are ALL inclusive there will be NO OTHER CHARGES for building fund, supplies, snacks etc. 

If you would like to consider becoming a Members, Chabad of Parkland Membership options are as follows:

Single Parent Family Membership

$360

Includes 1 High Holiday seat + Discounts throughout the year

Family Membership

$700

Includes 2 High Holiday seats + Discounts throughout the year

Partner Membership

$1800

Includes 4 High Holiday seats + Advertisement on our website


For Membership Application please  CLICK HERE

 

· Visa, Mastercard, Amex and Discover accepted.

· Payment plans are available please call 954.796.7330 to speak with Rabbi Gutnick. 


Pay in full
Pay in two equal installments one upon submission and the second on 1/1/2019. 

As per our discussion, an alternative payment plan has been arranged.
 

 I Will be sending in payment by check to  Chabad of Parkland Hebrew School • 7170 Loxahatchee Road • Parkland FL 33067

Name on card   Card Type
Card Number   CVV Code
Exp. Date   Zip Code
(If necessary) Payment Schedule Explanation:   Any additonal comments/notes

Please double check the form before submitting as auto fill for CC payment can automatically change the names submissions you put in at the top of the form 

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