Enrollment

We are currently accepting application forms for the upcoming school year. Please fill out all fields of this form. Space is limited for the coming year.

Please note that one registration form per child is needed.

If you have any questions or concerns you'd like to discuss with us, please contact us at (407) 970-3040

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

Tuition is $1,350 for the year (includes security fee & book fees)

Early Bird Special: $1,150 (ends 7/31)
I am:

A new studentA returning student
Student Profile:
Full Name:*
First Name: Last Name:
Hebrew Name: *
Gender: *
Birth Date*

Month Day Year
Time of Day:*
Hour Minutes
Family Information:

Address:*

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

Father's Name:*
Father's Birth Date:*

Month Day Year
Hebrew Name:*
Cell Phone Number:*

Area Code Phone Number
Mother's Name: *
Mother's Birth Date:*

Month Day Year
Hebrew Name:*
Cell Phone Number:*

Area Code Phone Number
Mother's E-mail:*
Father's E-mail:*
Marital Status:*

MarriedSingleDivorced
Religious and Educational:
Hebrew Reading Proficiency:*

NoneMarginallyWell
Does your child have any learning difficulties with General Studies?*

YesNo
If yes, please describe:
Was the natural mother of the child born Jewish?*

YesNo
Is the natural father of the child Jewish?*

YesNo
Was the maternal grandmother of the child born Jewish?*

YesNo
Are there any conversions and/or adoptions in the family?*

YesNo
Conversion Type:
Medical Information:
Is there any special medical or other information that we should be aware of?*

YesNo
If yes, please describe:
Does your child have any allergies?*

YesNo
Is your child currently taking any medication?*

YesNo
Family Physician:*
Emergency Contact #1:*
Relation: *
Phone Number:*

Area Code Phone Number
Medical Release:*

I hereby give consent to the administration of the Chabad Hebrew School to take whatever medical measures they deem necessary, at my expense, for my child in the event of a medical emergency.
Permission Slips:*

I hereby give permission to my child to participate in all school outings and field trips beyond school properties and to use any transportation selected by the Chabad Hebrew School.I grant permission for my child to be photographed in individual or group pictures which may be used by Chabad Hebrew School for P.R.
Are there any changes to your personal info from last year?*

YesNo
Please list changes:*
Payment Information:
For your convenience, you can now pay for Hebrew School online! This page uses a secure connection and your information will not be shared with anyone. Chabad Hebrew School does not reject anyone due to lack of funds. If you are in need of financial assistance please call our office at (407) 644-2400 Ext.#1
Payment Options:*
Yes, I would like to help sponsor a child's Jewish education!*
Total:

$0.00
Yes, I'd like to donate the cost of processing this transaction by adding 3%

Payment:

Credit Card

We accept Visa, MasterCard, American Express, Discover
Credit Card Number	Security Code
Name on Card
Expiration Month	Expiration Year

Billing Address

Street Address

City

State / Province

Postal / Zip Code

Country

Should be Empty:

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Educate Your Child... Educate a Generation

Student Profile:

Family Information:

Religious and Educational:

Medical Information:

Payment Information: