Printed from ChabadLakeSuccess.com

Full registration

Full registration

All JLE Hebrew Scholl students must fill out the form below before 1st day of Hebrew School

( all fields must be filled in below, if it doesn't apply to you please put a N/A in it

but every field needs to have something written in it)

No refunds are given and tuition is not pro-rated and due before Sep 1st.

Student Profile
Last Name
First Name
Hebrew Name
Age
DOB
School
Grade Entering
Hebrew Reading Proficiency None Somewhat Well
Previous Jewish Education Yes No
Where?
Does your child have any learning disabilities? Please specify
(This information will help us better cater to the needs of your child.)
Parent Information
Address
City/Zip
Phone
Father's Name
Father's Occupation
Father's Cell
Father's Email
Mother's Name
Mother's Occupation
Maternal Grandmother born Jewish?
Mother born Jewish?
Mother's Cell
Mother's Email
Emergency Information
Emergency Contact 1
Phone
Emergency Contact 2
Phone
Doctor's Name
Doctor's Phone Number

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. Or any other comments:




As the parent(s) or legal guardian of the above child, I/we authorize any adult acting on behalf of 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, 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 and allow my child to be photographed while participating in Chabad Hebrew School activities and that these pictures may be used for marketing purposes.

I Accept

Name: Initials: Date:


Part 2 PAYMENT
Parent
Last Name*
Parent
First Name*
Child #1 Last Name* Child #1 First Name*
Child #2 Last Name Child #2 First Name
Child #3 Last Name Child #3 Last Name
Payment and Address Information.

Lake Success Chabad family Members $680

Registration/Tuition Fee $880 -

3% percent is added for CC fees if paying by CC

How will you be paying?

Name on Card
Address City/State/Zip Code
Phone Email
Credit Card Num Exp Date
Security Code
Comments:


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

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