Registration

We are currently accepting application forms for the upcoming school year. Please fill out ALL fields of this form. We will only be accepting limited amount of new student applications for the coming year. If you have any questions or concerns you'd like to discuss with us, please contact us at 480-795-6292.

Please note that one registration form per child is needed.

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

Tuition Cost is $880 per child.

Full Name*

Hebrew Name:*

DOB:*

Month Day Year

Grade Entering:*

School:*

Allergies If any, please explain:

Doctor’s Name:*

Doctor's Address:

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

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

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:*

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

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 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

Emergency Information

Parent Information

Payment Information