Boys & Girls grade 1-6

Student Profile
Last Name
First Name
Hebrew Name
Grade Entering
Hebrew Reading Proficiency None Somewhat Well
Previous Jewish Education Yes No


Parent/Guardian Information
Parental Status   Married   Divorced   Single
Are there any conversions in the family?
Home Phone
Father's Name
Father's Occupation
Father's Cell
Father's Email
Mother's Name
Mother's Occupation
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.

Optional: Grandparents Information so we can share the "nachas"

For Carpenter School Parents


I will be bringing my child after school 

I will have someone else bring my child after school 

Name of person
Phone of person

I will be picking up my child after Hebrew School at 3:00pm

I will have someone else picking up my child after Hebrew school 

Name of person
Phone of person

Registration Payment Agreement
Tuition per child:

$1,300 full year + $100 registration fee. 

* includes books and supplies

Method of Registration payment: Credit Cards Only

Registration Fee (Mandatory)  $100

Tuition Full Payment  $1,300 Tuition Monthly Payment $140


Registration Payment
Name on Credit Card      
CC Type   Card Number
Billing Address   City, State, Zip
CVV   Exp Date

Amount to be charged now: $

As the parent(s) or legal guardian of the above child, I/we authorize any adult acting on behalf of Chabad Hebrew School 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 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 Chabad Hebrew School 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!