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Hebrew School Registration Form
Parent 1
First Name
*
Last Name
*
Phone Number
*
Email
*
Street Address
*
Street Address Line 2
City
*
State/Province
*
ZIP/Postal Code
*
Would you like to be a parent volunteer?
Parent volunteers are always appreciated! I would like to volunteer in special programming or have a skill/interest I’d like to share with the class (please type in above)
Religious affiliation
*
- Select -
Jewish
Other
Other religious affiliation
*
Parent 2
First Name
Last Name
Phone Number
Email
Relationship to Parent 1
- None -
Spouse of
Partner of
Ex-Spouse of
N/A
Same address
Same Address as Parent 1
Street Address
Street Address Line 2
City
State/Province
Postal Code
Religious affiliation
- None -
Jewish
Other
Other religious affiliation
Child information
First Name
*
Last Name
*
Birth Date
*
Month
Month
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Day
Day
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Year
Year
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
2017
2018
2019
2020
2021
2022
2023
Same address as
- None -
Parent 1
Parent 2
Street Address (where child resides)
*
Street Address Line 2
City
*
State/Province
*
Postal Code
*
School Selection
*
K-6 program | Village Hebrew 23-24 - September 13th, 2023
3s and 4s program | Village Hebrew 23-24 - September 13th, 2023
School/Education
Previous Hebrew education?
*
Yes
No
Hebrew reading proficiency
*
- Select -
Well
Somewhat
None
Grade attending
*
- Select -
Preschool
K
1
2
3
4
5
6
7
8
9
10
11
12
School attending
*
Tuition amount due today
$
Does your child have any allergies or other medical conditions we should be aware of?
*
Yes
No
Please describe them and indicate special precautions or care needed.
*
Emergency Contact
First Name
*
Last Name
*
Phone Number
*
Relationship to Child
*
Terms of agreement
Chabad West Village is committed to creating a safe and healthy environment for children and it is our hope that the use of the following releases will never be needed.
Consent
*
As the parent/guardian of the above child/ren, I authorize any staff member of person acting on behalf of Chabad West Village to administer first aid, hospitalize or secure treatment for my child. Chabad West Village will make every effort to reach a parent/ legal guardian, and will use the authorization of this form when time and circumstance doesn’t allow for waiting to contact a parent. I agree to pay all charges associated with care and/or treatment..
Marketing
*
I grant permission to Chabad West Village, its employees and representatives to use images of my child taken in conjunction with Chabad West Village for publications such as electronic material, newsletters, social media outlets, and advertising.
Trips
*
I hereby give my child permission to participate in Chabad West Village trips.
Digital signature of parent of guardian
*
Enter your full legal name here
Tuition Payment Options
In Full
2 payments
Pay Later
Interval of Installments
Chabad West Village
office@chabadwestvillage.com
|
212 518 3122
|
New York, NY 10014
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