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Hebrew School Registration

Registration is always open! Please fill out ALL fields of this form. If you have any questions or concerns you'd like to discuss with us, please contact us .
Please note that one registration form per child is needed. We look forward to a wonderful year of learning and growth.
Click here to apply for a scholarship.
Child's Information
Child's Name*
First NameLast Name
Hebrew Name*
Birth Date*
MonthDayYear
Current School*
Current Grade*
Future School*
Grade entering*
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
Is the biological mother of the child Jewish?*
YesNo
Were there any conversions or adoptions in your family?*
YesNo
If there has been a conversion, please indicate which Bet Din officiated:
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
Parent/Guardian 1:*
PrefixFirst NameLast Name
Parent/Guardian 1 Cell:*
Area CodePhone Number
Home Phone:Enter if used as primary phone
Area CodePhone Number
Parent/Guardian 2:*
PrefixFirst NameLast Name
Parent/Guardian 2 Cell:*
Area CodePhone Number

Primary Address:*Enter primary address where child resides.

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

Secondary Address:Enter secondary address or address of Parent 2

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

Parent/Guardian 1 E-mail:*
Parent/Guardian 2 E-mail:*
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:*
Doctor:*
First NameLast Name
Phone Number:*
Area CodePhone Number
Payment
Tuition includes complete year of weekly school, registration & book fees, supplies and snacks. Ask us about our referral reward!
Referral program
I referred families to Skokie Chabad Hebrew SchoolSkokie Chabad Hebrew School was referred to me by a friend.
Enter referral names here:
I am paying for:*
Hebrew School : Full Payment ($700)Hebrew School : Half Payment ($350)Contact us for payment plan options.
Optional: I'm aware that many students are on a scholarship. Please put this additional amount towards the tuition of a fellow student in need.
$50$100$350$700
Total
$0.00
Yes, I'd like to donate the cost of processing this transaction by adding 3%

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

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, join in class and school trips on and beyond school properties. 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
We look forward to a wonderful year of learning and growth
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