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Register Online



September 11, 2016 - June 4, 2017
Contact our director with any questions

Register Now!

We are currently accepting application forms for the 2017- 2018 school year. 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.

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

Student Information
Child 1:
Child's Name Hebrew Name
Date of Birth Time of Birth AM PM
School Attending Grade Entering
(Sep. 2017)
Previous Jewish Education Yes No Where?
Hebrew Reading Proficiency None Somewhat Well    
       
Child 2: (if applicable)
Child's Name Hebrew School
Date of Birth Time of Birth AM PM
School Attending Grade Entering
(Sep. 2017)
Previous Jewish Education? Yes No Where?
Hebrew Reading Proficiency None Somewhat Well    
 
Parent Information
Marital Status Child Lives With
Is the natural mother and maternal grandmother of the child Jewish? Yes No
 
Father
Title/ First Name Last name
Work Phone Cell Phone
Occupation Email
 
Mother
Title/ First Name Last name
Work Phone Cell Phone
Occupation Email
 
Home
Address City
State / Zip Home Phone

Have there been any conversions or adoptions in the family? Yes No If Yes, please explain:
Main Expectation: Jewish Heritage Hebrew Language Social Jewish Environment All
Primary Mail Correspondence: Mother Father Both
 
General Information
Other person authorized to pick up child:

Name Cell Relation
Parent Volunteers are always appreciated!
I am available to volunteer as a chaperone for local field trips, assist in special programming or have special interests or skills I would like to bring into the classroom:
Comments

Referred by
 
Emergency Information
Emergency Contact 1 Phone
Emergency Contact 2 Phone
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.
As the parent(s) or legal guardian, 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 attend all field trips and outings sponsored by Chabad Hebrew School.
 
Payment Information
• The tuition for the Chabad Hebrew School is $770 per year per child. If you are unable to pay please call our office for a scholarship. We will not turn a child away because of a lack of funds.

• Make checks payable to “Chabad of Fort Lee” and mail to “808 Abbott Blvd. Fort Lee, NJ 07024”.

• I allow pictures to be taken of my child for school use.
 
Card Number Billing Address
Expiration CVV Code What's This?

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