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Returning Students - Registration

Returning Students - Registration

Hebrew School Registration Form
2016/2017

Student’s information

Name:

For additional child

Name:

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.

Parent initials:

Date:

Tuition

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

Card type:

Card number:

Expiration - Month: Year:

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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First day of Hebrew School for 2015 is September 20.
Looking forward! 
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