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Welcome!

Chabad Hebrew School

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Sundays 10am-12pm

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Registration

Student Information
Child's Name*

First Name Last Name
Child's Hebrew Name
Child's Birth Date*

Month Day Year
Does your child read basic Hebrew?
If Yes
What school does your child attend
What Grade is your child in*
Is the biological mother of this child Jewish?
Were there any conversions or adoptions in the family?
If yes please explain
Parent Information
Mother's Name

First Name Last Name
Mother's Phone Number

Area Code Phone Number
Mother's E-mail
Father's Name

First Name Last Name
Father's Phone Number

Area Code Phone Number
Father's E-mail

Address

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

Emergency Information
Emergency Contact

First Name Last Name
Phone

Area Code Phone Number
Allergies or other medical conditions
I would like to receive news and updates by email
Tuition per child*

Tuition $595 I would like a Scholarship, please call me to discuss
Total

$0.00

Payment*

Credit Card Check

Postal / Zip Code

Country

100% of the proceeds of this donation or payment will benefit Chabad of Palm Beach Gardens.
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