Hebrew School Registration

Student Information
Full Name*
First Name Last Name
Hebrew Name*
First Name Last Name
Birth Date* Time allows us to calculate Hebrew birthday

Month Day Year
at Hour Minutes
School*
Previous Jewish Education
Grade entering*

Address*

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Additional notable Information Please let us know if there are any allergies or other important information we need to be aware of.
Does your child have any special learning needs or an IEP?
For information about the New Sunday Option 10 - 12am. Check this box or email [email protected]
Parents Information
Father's Name*
First Name Last Name
Father's Cell*

Area Code Phone Number
Father's Email
Father's Hebrew Name
Mother's Name*
First Name Last Name
Mother's Cell*

Area Code Phone Number
Mother's Email
Mother's Hebrew Name
Is the natural mother of the child born Jewish*

YesNo
Are there any conversions in the family?*

YesNo
If yes, please include who converted and name of officiating rabbi
Are there any adoptions in the family?*

YesNo
If yes, please explain
I am willing to assist in school activities, please contact me
Emergency Info
Doctor's Name

Doctor's Address

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Allergies If any, please list
Medical Conditions and/or Medications If any, please explain
Emergency Contact 1
First Name Last Name
Phone Number

Area Code Phone Number
Relationship
Emergency Contact 2
First Name Last Name
Phone Number

Area Code Phone Number
Relationship
As the parent(s) or legal guardian, I/we authorize any adult acting on behalf of Chabad Hebrew School of Lubavitch of Abington Inc. 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 attend all field trips and outings sponsored by Chabad Hebrew School. I also allow Chabad to use my child’s picture for promotional purpose
Initials to indicate approval
For additional children, please fill out additional forms. You may fill out only the child's info, medical info, and tuition agreement.
Payment
Fees

Cost for the 2024-2025 School Year is $760 (registration & book fee included).

Payment Plans
- Full payment of $760.
- Credit Card payments in monthly installments of $152 each, charged on the first of each month for Seven months, beginning September 1, 2024.
- If you need to arrange a different payment plan, please don’t hesitate to call and discuss it with us.
Select Plan

Full payment of $760Credit Card payments in monthly installments of $152 each, charged on the first of each month for Seven months, beginning September 1, 2024Other
I would like to assist a child who cannot afford Hebrew School Education

$760 - full tuition$380 - half tuition$190 - quarter tuitionOther
E-mail*

Payment

Credit Card Paypal Other

Postal / Zip Code

Country

I would like to receive news and updates by email
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Educate Your Child... Educate a Generation

Student Information

Parents Information

Emergency Info

Payment