Register Online

We are currently accepting application forms for the 2018-2019 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.

If you would prefer to fill out this form and mail it into our office you may do so, simply by filling out the form and mailing it to: 1755 Grantham Place, Wellington, Florida 33414.

Please note that one registration form per child is needed.

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

 

Student Profile
 
Name
Last
Hebrew Name
DOB
School
Grade Entering
Hebrew Reading Proficiency None Somewhat Well
Previous Jewish Education Yes No
Where?
Is the natural mother of the child Jewish?  Yes No
 
Were there any conversions or adoptions in your family? Yes No
 
If yes, please describe:
 

 

Parent Information
 
Father's Name
Phone
Mother's Name
Phone
Address
City
State
Zip
Email Address

 

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 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:

 

PAYMENT OPTIONS

Registration Fee/Supplies/Book Fee: $75 
 
Tuition: $675

Register additional children and receive 10% off their tuition!
Please charge my card $75.00 registration fee*
* All online forms will be reviewed by Chabad Hebrew School. By completeing this form your child is not fully registered until Chabad Hebrew School contacts you.
 
Credit Card Information:
Name on card   Card Type
Registration Fee:   Card Number
      Charge amount:
Exp. Date   CVV Code 3 digits on back of card