Walker Hebrew Club Registration 2018-19 - Lubavitch Chabad of Skokie

Walker Hebrew Language Club
Registration for Hebrew Club 2018-2019
Child's Information
Child's Name*
First NameLast Name
Hebrew Name*
Birth Date*
MonthDayYear
Grade at Walker School in 2018-2019 school year:*
Classroom Teacher at Walker School for 2018-2019 school year:*
Has your child had any previous formal Jewish Education?*
SomeNone
If yes, please describe:
Hebrew reading proficiency:*
None - my child cannot yet read HebrewSome - my child can read a bit of HebrewWell - my child is fluent in Hebrew reading
CONFIDENTIAL: Does your child have any allergies or other medical condition we should be aware of? If yes, please describe them and indicate special precautions or care needed.
Parents' Information
Mother's Name:*
First NameLast Name
Mother's Cell:*
Area CodePhone Number
Home Phone:*
Area CodePhone Number
Father's Name:*
First NameLast Name
Father's Cell:*
Area CodePhone Number

Address:*

Mother's E-mail:*
Father's E-mail:*
How will the child go home?
Parent PickupSchool-aged Childcare
Emergency Information
Emergency contact 1:*
First NameLast Name
Phone Number:*
Area CodePhone Number
Relationship to child:*
Emergency contact 2:*
First NameLast Name
Phone Number:*
Area CodePhone Number
Relationship to child:*
Payment
Tuition is paid per session. Refunds only occur in case of insufficient enrollment. There are no make-up dates.
I am paying for:*
Walker Hebrew Language Club - Session 1 / Fall Classes (September 13, 2018- November 29, 2018)Walker Hebrew Language club - Session 2 / Winter classes (December 13, 2018-February 28, 2019)Walker Hebrew Language Club - Session 3 / Spring classes (March 7, 2019 - May 16, 2019)
Total
$0.00
Comments:

Payment

Credit Card

Billing Address

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Country

As the parent(s) or legal guardian of the above child, I/we authorize any adult acting on behalf of Skokie Chabad Hebrew School to hospitalize or secure treatment for my child, I further agree to pay all charges for that care and/or treatment. It is understood that if time and circumstances reasonably permit, Skokie Chabad Hebrew School personnel will try, but are not required, to communicate with me prior to such treatment. I hereby give permission for my child to participate in all school activities. I allow my child to be photographed while participating in Skokie Chabad Hebrew School activities and acknowledge that these pictures may be used for marketing purposes.
*
I Accept
Name*
Initials*
Should be Empty: