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Hebrew School Registration

Hebrew School Registration

Hebrew School Registration Top copy.jpg

 

 FAMILY INFORMATION
  Family Name      
 Address       City  
 Zip Code    Home Phone  
 Father's Name    Hebrew Name   
 Father's Email    Father's Cell  
 Mother's Name    Hebrew Name   
 Mother's Email    Mother's Cell  
 Marital Status of Parents   Conversions in the family?  
 Is the Father Jewish?    Is the Mother Jewish?  

 

 CHILD INFORMATION
 1. Child's Name    Hebrew Name  
 Date of Birth    Hebrew Birthday   
 School Attending    Grade Entering  
 Is the child adopted?    Allergies to food or medications?  
 Need for an epi-pen?    Previous Hebrew Reading Knowledge?  
       
 2. Child's Name    Hebrew Name  
 Date of Birth    Hebrew Birthday  
 School Attending    Grade Entering  
 Is the child adopted?    Allergies to food or medications?  
 Need for an epi-pen?     Previous Hebrew Reading Knowledge?  
       
 3. Child's Name    Hebrew Name  
 Date of Birth    Hebrew Birthday  
 School Attending    Grade Entering  
 Is the child adopted?    Allergies to food or medications?  
 Need for an epi-pen?     Previous Hebrew Reading Knowledge?  
       
 4. Child's Name    Hebrew Name  
 Date of Birth    Hebrew Birthday  
 School Attending    Grade Entering  
 Is the child adopted?    Allergies to food or medications?  
 Need for an epi-pen?     Previous Hebrew Reading Knowledge?  

 

 Please list name(s) of those (other than parents) who are authorized to pick up from school  :
 

 

  TUITION & PAYMENT
  The following document is a tuition agreement for the Chabad Hebrew School. The agreement explains the tuition fees, payments plans and refund policies. Please read it through carefully and sign at the end of the document. The signed tuition agreement along with payment must be submitted to the school office before any child will be permitted to attend classes.

 The tuition for the Chabad Hebrew School is $700.00 per year per child (this includes a registration & book fee).

You may choose from the following payment methods. Please fill in your choice. 

 

 Plan A : Pay full amount now  Check/Cash   Credit Card  Amount Due: 
     
 Plan B : You may pay the annual tuition over a five month period by submitting 5 checks dated September through January, or having your credit card billed 5 times. All checks must be submitted before the first day of Hebrew School.   Check/Cash  Credit Card Due Per Month: 
     
 Name on Card     
 Billing Address    Zip Code   
 Card Number    
 Expiration Date    

 MEDICAL & BEHAVIORAL HISTORY
 Does your child's (indicate which child) have any medical, developmental or behavioral issue that we should know about? Describe:

 MEDICAL EMERGENCIES
 I authorize the staff of Chabad of Plantation to seek appropriate medical care for my child, if necessary.  
 In case of emergency, when neither parent can be reached, give names of two people who will take responsibility for your child:   
 Emergency Contact 1    Emergency Contact 2  
 Name    Name  
 Home Phone    Home Phone  
 Cell Phone    Cell Phone  
 Address    Address  
 Relationship to Child    Relationship to Child  
       
If parents cannot be reached and emergency medical advice is needed, permission is given to the Hebrew School staff to phone my child's doctor:
 Doctor    Phone  
 Address     City  
As the parent(s) or legal guardian we authorize any adult acting on behalf of Chabad Hebrew School/After School Program 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/After-School Program personnel will try, but are not required, to communicate with me prior to such treatment.    

 

ENROLLMENT AGREEMENT  
Enrollment is considered to be for the entire school year.  The school cannot issue refunds or credits for illness, holidays, family vacations or early withdrawal.  In the event that the school is closed due to or resulting from a weather emergency or other unforeseen circumstances, there will be no make-up days, refunds or credits for days that school is not in session.

I hereby give permission for my child to attend all field trips and outings sponsored by Chabad Hebrew School/After-School Program and any photos/videos from throughout the year to be used in our publications/advertising online or in print. 

This signature must be that of the individual "signing" this document electronically or be made with the full knowledge and permission of the individual, otherwise it constitutes forgery under s.831.06, Florida Statutes.

The Parent will need to type their name below to accept all the above agreements.

 Father's Name    Date  
 Mother's Name    Date  

 

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