Hebrew School Registration Form
For additional child
Health, trip and picture waiver.
As the parent(s) or legal guardian of the above child, I/we authorize any adult acting on behalf of the Chabad Hebrew School to hospitalize or secure treatment for my child in the event of a medical emergency, I further agree to pay all charges for that care and/or treatment. It is understood that if time and circumstances reasonably permit, the 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 participate in all school activities, join in class and school trips on and beyond school properties
I allow my child to be photographed while participating in the Chabad Hebrew School activities and that these pictures may be used for marketing purposes.
Please check your choice for method of payment:
For one child
I will send a check for the full payment of $700
I will send four post-dated* payments of $175
Please charge my card for the full payment of $700
Please charge my card for four payments* of $175
For two children
Includes 10% discount for additional child
I will send a check for the full payment of $1,330
I will send four post-dated* payments of $332.50
Please charge my card for the full payment of $1,330
Please charge my card for four payments* of $332.50
Expiration - Month:
3 (for Amex 4) digit security code:
*Sept 11 2016
Nov. 1 2016
Jan 1 2017
March 1 2017
Please make checks payable to Chabad of West Orange County.
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