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New Student Registration Form

ENROLLMENT FORM

Chabad Hebrew School 2024/25
Number of Children Registering:*
Child 1:*

First Name Last Name
Child 1 Registration:*

$1350 for the year: Aleph Champ individualized reading plus Hebrew school Club$725 Hebrew School Club without individual reading sessionsIndividual Sessions - specify below.
Individual Sessions Child 1:*

Session 1: September 15- November 24 (11 weeks) - $308Session 2: December 8- February 9 (8 weeks) - $224Session 3: March 2- May 18 (10 weeks) - $2801 Individual Class - $28
Please specify date child will be attending:*

Month Day Year
Child's hebrew name:*

First Name Last Name
Date of birth:*

Month Day Year
Grade (2024/25):*
Does your child require a Behavior Intervention Plan? Or behavior / management strategies to promote positive behavior?

If so, please describe.
Child 2:*

First Name Last Name
Child 2 Registration:

$ 1350 for the year: Aleph Champ individualized reading plus Hebrew school Club$ 725 Hebrew School Club without individual reading sessionsSession 1: October 15-Dec 17 (8 weeks) $200Session 2: Jan 7- Feb 11 (6 weeks) $180Session 3: March 3-April 14 (6 weeks) $180Session 4: May 5-May 19 (3 weeks) $100Individual class: $25
Child 2 Date of birth:*

Month Day Year
Child 2 Hebrew name:*

First Name Last Name
Grade (2024/25):
Child 2 Registration:

$1350 for the year: Aleph Champ individualized reading plus Hebrew school Club$725 Hebrew School Club without individual reading sessionsIndividual Sessions - Specify below
Individual Sessions Child 2:*

Session 1: September 15- November 24 (11 weeks) - $308Session 2: December 8- February 9 (8 weeks) - $224Session 3: March 2- May 18 (10 weeks) - $2801 Individual Class - $28
Please specify date child will be attending:*

Month Day Year
Child 2 Does your child require a Behavior Intervention Plan? Or behavior / management strategies to promote positive behavior?

If so, please describe.
Child 3:

First Name Last Name
Child 3 Hebrew name:

First Name Last Name
Child 3 Date of birth:

Month Day Year
Grade (2024/25):
Child 3 Registration:

$1350 for the year: Aleph Champ individualized reading plus Hebrew school Club$725 Hebrew School Club without individual reading sessionsIndividual Sessions - Specify below
Individual Sessions Child 3:*

Session 1: September 15- November 24 (11 weeks) - $308Session 2: December 8- February 9 (8 weeks) - $224Session 3: March 2- May 18 (10 weeks) - $2801 Individual Class - $28
Please specify date child will be attending:*

Month Day Year
Child 3 Does your child require a Behavior Intervention Plan? Or behavior / management strategies to promote positive behavior?

If so, please describe.
Child 4:

First Name Last Name
Child 4 Hebrew name:

First Name Last Name
Child 4 Date of birth:

Month Day Year
Grade (2024/25):
Child 4 Registration:

$1350 for the year: Aleph Champ individualized reading plus Hebrew school Club$725 Hebrew School Club without individual reading sessionsIndividual Sessions - Specify below
Individual Sessions Child 4:*

Session 1: September 15- November 24 (11 weeks) - $308Session 2: December 8- February 9 (8 weeks) - $224Session 3: March 2- May 18 (10 weeks) - $2801 Individual Class - $28
Please specify date child will be attending:*

Month Day Year
Child 4 Does your child require a Behavior Intervention Plan? Or behavior / management strategies to promote positive behavior?

If so, please describe.
Click here if all the details are the same as last year - and then no need to refill this form, Go straight to the payment

Address

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

Home phone:

Area Code Phone Number
Mother's (or guardian's) name:

First Name Last Name
Occupation:
Business phone:

Area Code Phone Number

Business address:

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

Cell phone:

Area Code Phone Number
E-mail
Father's (or guardian's) name:

First Name Last Name
Occupation:
Business phone:

Area Code Phone Number

Business address:

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

Cell phone:

Area Code Phone Number
E-mail
Student Information:
Is the biological mother Jewish? *

YesNo
Is the biological father Jewish?*

YesNo
Were there any conversions or adoptions in the family? *

YesNo
If Yes, who was the Rabbi?*
Additional comments: any educational concerns that will help us with your child:
I would like to sponsor the Jewish education of another child for $1000.
I would like to contribute:

$36$72$180$360
Please call me to arrange a payment planPlease send me a scholarship application formPlease apply the new family discount ($100) to our total.
Total

$0.00

I would like to pay today:Full amount10% minimum: $0.00 $

Payment*

Credit Card Check

Postal / Zip Code

Country

*No child is turned away due to lack of funds
**Registration will not be not accepted without full payment or without a completed scholarship form or payment plan form.
I allow CHS to take pictures of my child/ren for our website and other PR purposes
Volunteer:
I would like to volunteer at Chabad. My area of expertise:

ComputersHandymanOrganizationGraphic Design
Emergency File:
Doctor's name:*

First Name Last Name
Doctor's phone:*

Area Code Phone Number

Doctor's address: *

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

Allergies:
Medical Conditions:
Other:
PLEASE LIST BELOW TWO EMERGENCY CONTACTS :
Contact 1: Name, Phone, Relationship:*
Contact 2: Name, Phone, Relationship:*
PERMISSION FOR EMERGENCY MEDICAL TREATMENT:
*

As the parent(s) or legal guardian of , I/we authorize any adult acting on behalf of Chabad of Briarcliff's 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.
Initials of Parent or Legal Guardian: *
Comments:
Should be Empty:

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