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Tuition Agreement

Tuition Agreement

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B”H

CHABAD HEBREW SCHOOL FORMS

Tuition is $800 per year. Meets Sundays 9:30am-11:30am

Registration Application 2017-2018

Please Print Clearly and Return to Office:
 

Part I: Student Information

Last Name

 

First Name

 

Hebrew Name

 

e-mail (child’s)

 

Address

 

City

 

Zip

 

Phone

 

Birthday

 

Age

 

School

 

Grade (Entering)

 


Part II: Parents’ Information

Father’s Name

 

Hebrew Name

                

Work Address

 

Phone

 

Occupation

 

Mother’s Name

 

Hebrew Name

 

Work Address

 

Phone

 

Occupation

 

e-mail (parent)

 

Synagogue Affiliation

 

Father cell #

 

Mother Cell #

 


Part III: Religious & Educational History

Previous Hebrew Education

 

Were there any conversions &/or adoptions in the family? (child, parent, grandparent, great grandparent both sides…)

 

If yes, what is the relation to the child?

 


Where were the conversion done? Who was the Rabbi who performed the conversion and which temple aviliation?

 


Part IV: Medical Information  (confidential)


Up to date with vaccinations?

 

Yes

 

No

   

Any special medical or other information, which we should be aware of including allergies?(Confidential)

 
 









Please Print Clearly and Return to Office:

Registration Application 2017-2018


___ I have included the $150 deposit towards the tuition payment.


___ I have included the payment in full.


___ I have included checks posted for the 1st of each month.


Please bill my credit card for $_____ on the 1st of Each month, September 2017-May 2018.


CC INFO

Type ________ Number ______________________________


EXP ________ CVC _________

For other options, please call 714-693-0770.

Chabad does not turn away any Jewish families due to lack of funds.

I hereby permit my child, _____________________________________to participate in all school activities, and to join in class and school trips on and beyond school properties and use any transportation selected by the Chabad Hebrew School.
Signature of parent________________________________Date:__________________

Emergency Contact Information
Person to be contacted in case of an emergency when parents cannot be reached:

Name

 

Telephone #

(      )       -         

Relationship to child

 

City/Town

 

Family Physician

 

Telephone #

(      )       -         

Medical Insurance Co.

 

Policy #

 

Medical Release Form

I hereby give consent to the administration of the Chabad Hebrew School to take whatever medical measures they deem necessary, at my expense, for my child in the event of a medical emergency.

Signature of parent________________________________Date______________

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