Registration Form

Class Options:
Payment Options

$200 a month - Hebrew School Classes (Monday at Chabad)$75 a class - Private Tutoring at Home$50 a class - Private Pod Classes at Chabad$45 - Drop in trial class
Other Amounts Input amount.

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Parent/Guardian Information:
Full Name*
First Name Last Name
E-mail*
Phone*

Address*

Child Information
Full Name*
First Name Last Name
Date of Birth*

Month Day Year
Gender*

MaleFemale
Grade/Year in School*
Allergies/Medical Conditions (if any)
Special Needs/Requirements (if any)
Emergency Contact Information
Emergency Contact Name*
First Name Last Name
Relationship to Child*
Phone Number
Alternative Phone Number*
Additional Information
Additional Information
How did you hear about Chabad Hebrew School of the Arts?*
Are you affiliated with any synagogue or Jewish community center?*

YesNo
If yes, please specify*
Consent and Agreement
By submitting this form, I confirm that all information provided is accurate to the best of my knowledge. I consent to my child's participation in activities organized by Chabad Hebrew School of the Arts and understand that photos/videos may be taken during events for promotional purposes.
Signed by*
Date Signed*

Month Day Year

Payment*

Credit Card Paypal

Postal / Zip Code

Country

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Class Options: