Student Information
Last Name
First Name
Hebrew Name
Grade Entering
Hebrew Reading Proficiency None    Somewhat    Well
Previous Jewish Education Yes            No
Any consideration, such as learning disorder or difficulty the school should be aware of (confidential)   

Parent Information
Father's Name
Father's Occupation
Father's Cell
Father's Email
Mother's Name
Mother's Occupation
Mother born Jewish?  Converted by whom? 
Mother's Cell
Mother's Email

Emergency Information
Emergency Contact 1
Emergency Contact 2
Doctor's Name
Doctor's Phone Number
Medical Insurance Company
Policy Number

CONFIDENTIAL: Does your child have any allergies or other medical condition we should be aware of?  If yes, please describe them and indicate special precautions or care needed. 



Tuition Agreement
The following 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. If paying by check or cash, full payment/plans must be submitted to the school office before any child will be permitted to attend classes. 
Tuition for the year, per child: $750 
Book Fee:  $25
Discount: There is a 5% discount off of the regular tuition for each additional child of the same family. There is a 10% additional discount off your total tuition for each child of another family you successfully introduce to the Chabad Hebrew School.
You may choose from the following payment methods: 

Please note: Cheder will not turn anyone away due to a lack of funds for tuition assistants please contact us ()

 Method of payment:
Credit Card
Check in the mail
Credit Card Information
Credit Card Number   Billing Address  
City   State, Zip  
Charge Amount   Exp Date  


  As the he parent(s) or legal guardian of the above child, I/we authorize any adult acting on behalf of Cheder 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, Cheder 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 and allow my child to be photographed while participating in Cheder activities and that these pictures may be used for marketing purposes.

I Accept    

Name:     Initials:  Date: 

We look forward to a wonderful year of learning and growth!