Hebrew School 2022-2023

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 *

Other religious affiliation *

Parent 2

First Name

Last Name

Phone Number

Relationship to Parent 1

Same address

Same Address as Parent 1

Street Address

Street Address Line 2

City

State/Province

Postal Code

Religious affiliation

Other religious affiliation

Child information

First Name *

Last Name *

Birth Date *

Month

Day

Year

Same address as

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

Hebrew reading proficiency *

Grade attending *

School attending *

Tuition amount due today $

Does your child have any allergies or other medical conditions we should be aware of? *

Yes

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