Registration - Chabad Lubavitch of Fountain Hills

Doctor's Address:

Medical Conditions If any, please explain:
Emergency Contact Other Than Parent:*
Phone Number*

Area Code Phone 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:
Are the natural father and mother of the child Jewish?*

YesNo
Any adoptions or conversions in the family?*

YesNo
If Yes, Please Explain:
What goals do you have for your child attending Hebrew School?*
Hebrew Reading Proficiency: *

NoneSomewhatWell
Previous Jewish Education:*

YesNo
Where?
Name of Sibling:
Birth Date of Sibling:

Month Day Year
Name of Sibling:
Birth Date of Sibling:

Month Day Year
Name of Sibling:
Birth Date of Sibling:

Month Day Year
Parent Information
Father's Name:*
First Name Last Name
Phone Number:*

Area Code Phone Number
Mother's Name:*
First Name Last Name
Phone Number:*

Area Code Phone Number
If no please explain:

Address:*

Father's email:*
Mother's email:*
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, 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 and allow my child to be photographed while participating in the Chabad Hebrew School activities and that these pictures may be used for marketing purposes.
*

I hereby give permission for my child to attend all field trips and outings sponsored by Chabad Hebrew School.
*

I hereby give permission for my child to be photographed. Photos may be used for promotional purposes for Chabad Lubavitch of Fountain Hills.
Full Name of Parent:*
First Name Last Name
Initials:*
Payment Information
Your application is not complete without a payment plan.Chabad Hebrew School does not reject anyone due to lack of funds. If you feel that you need a special payment plan please call our office at 480-795-6292. Tuition Cost is $880 per child.
Payment options: *

Pay in full - $880Pay in two installments; Today and 1/1. ($440)
Total to be charged today:

$0.00

Payment*

Credit Card Other

Postal / Zip Code

Country

Student Profile