Enrollment

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. 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) 644-2500 Ext:0.
We look forward to a wonderful year of learning and growth!
I am:
A new studentA returning student
Student Profile:
Full Name:*
First Name:Last Name:
Hebrew Name:*
Gender:*
Grade entering in September:*
Birth Date*
MonthDayYear
Time of Day:*
HourMinutes
School Currently Attending:*
Family Information:

Address:*

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

Home Phone Number:*
Area CodePhone Number
Father's Name:*
Father's Birth Date:*
MonthDayYear
Hebrew Name:*
Work Phone Number:
Area CodePhone Number
Cell Phone Number:*
Area CodePhone Number
Father's Occupation:*
Mother's Name:*
Mother's Birth Date:*
MonthDayYear
Hebrew Name:*
Work Phone Number:*
Area CodePhone Number
Cell Phone Number:*
Area CodePhone Number
Mother's Occupation:*
Mother's E-mail:*
Father's E-mail:*
Which email would you like used for updates and newsletters?*
Mother'sFather'sBoth
Marital Status:*
MarriedSingleDivorced
Religious and Educational:
Previous Jewish Education:*
Hebrew Reading Proficiency:*
NoneSomewhatWell
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:*
Physician's Phone Number:*
Area CodePhone Number
Medical Insurance Company:*
Policy #:*
Emergency Contact #1:*
Relation:*
Phone Number:*
Area CodePhone Number
Emergency Contact #2:*
Relation:*
Phone Number:*
Area CodePhone 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 review my options to help out!*
Total:
$0.00

Payment:

Credit Card

Credit Card Type
Credit Card Number	Security Code
Name on Card
Expiration Month	Expiration Year

Billing Address

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Country

Should be Empty:

This page uses TLS encryption to keep your data secure.

Student Profile:

Family Information:

Religious and Educational:

Medical Information:

Payment Information: