ENROLLMENT FORM Chabad Hebrew School 2024-25 Number of Children Registering:* Child 1:* First Name Last Name Child 1 Registration: Session 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) $100One full year of Hebrew School Club (11:00 am - 12:00 pm) $550Private Hebrew reading (10:30-11:00am) $625 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. Child 1 Registration:* 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:* 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 sessionsIndividual Sessions - specify below. Child 2 Registration:* 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:* First Name Last Name 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. Child 3 Registration:* 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:* First Name Last Name 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. Child 4 Registration:* 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 Has any information changed since last year? Please specify: 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 form Total $0.00 I would like to pay today:Full amount10% minimum: $0.00 $ Payment* Credit Card Check Credit Card We accept Visa, MasterCard, American Express, Discover Credit Card Number Security Code Name on Card 1 - January 2 - February 3 - March 4 - April 5 - May 6 - June 7 - July 8 - August 9 - September 10 - October 11 - November 12 - December Expiration Month 2024 2025 2026 2027 2028 2029 2030 2031 2032 2033 Expiration Year Billing Address Street Address City State / Province Postal / Zip Code Please Select United States Afghanistan Albania Algeria American Samoa Andorra Angola Anguilla Antigua and Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan The Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bosnia and Herzegovina Botswana Brazil Brunei Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Chile People's Republic of China Republic of China Christmas Island Cocos (Keeling) Islands Colombia Comoros Congo Cook Islands Costa Rica Cote d'Ivoire Croatia Cuba Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Eswatini Ethiopia Falkland Islands Faroe Islands Fiji Finland France French Polynesia Gabon The Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guernsey Guinea Guinea-Bissau Guyana Haiti Honduras Hong Kong Hungary Iceland India Indonesia Iran Iraq Ireland Israel Italy Jamaica Japan Jersey Jordan Kazakhstan Kenya Kiribati North Korea South Korea Kosovo Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macau Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia Moldova Monaco Mongolia Montenegro Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island Northern Mariana Norway Oman Pakistan Palau Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Islands Poland Portugal Puerto Rico Qatar Romania Russia Rwanda Saint Barthelemy Saint Helena Saint Kitts and Nevis Saint Lucia Saint Martin Saint Pierre and Miquelon Saint Vincent and the Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands Somalia Somaliland South Africa South Ossetia Spain Sri Lanka Sudan Suriname Svalbard Sweden Switzerland Syria Taiwan Tajikistan Tanzania Thailand Timor-Leste Togo Tokelau Tonga Trinidad and Tobago Tristan da Cunha Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu Uganda Ukraine United Arab Emirates United Kingdom Uruguay Uzbekistan Vanuatu Vatican City Venezuela Vietnam British Virgin Islands US Virgin Islands Wallis and Futuna Western Sahara Yemen Zambia Zimbabwe Other 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. 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