REGISTRATION FORM 2019 - 2020

 

 Child Information (if enrolling more than one child please copy and complete child information).   

 

Last name..................................... First Name    .........................................  

 

Hebrew Name    ............................. D.O.B. ....../....../...... Entering Grade (Fall 2019) .............  

 

 

My Child: (check one) Does not read Hebrew.......   Recognizes letters of the Alef-Bet......  

 

                                 Can read Hebrew slowly...... Can read Hebrew very well......  

 

Does your child have any special learning or behavioral needs? ...........................................  

 

......................................................................................................................................  

 

Any pertinent health information or Allergy? .........................................................................  

 

......................................................................................................................................  

_____________________________________________________________________________  

 

Family Information  

 

Are the natural mother, maternal grandmother and father Jewish? Yes.......... No   ...........  

 

If no, please explain .......................................................................................................  

 

.....................................................................................................................................  

 

 

 

 

 

 

Have there been any conversions or adoptions in your family? Yes   .......... No ..........  

 

If yes, please explain   .....................................................................................................  

 

....................................................................................................................................  ___________________________________________________________________________  

 

Parent Information  

 

Address ......................................................................................................................  

 

City   ................................................................................... Zip.................  

 

                     Father                                         Mother  

 

First Name: ..............................................        ...............................................................  

 

Cell Phone: .............................................        ...............................................................  

 

Home Phone: ............................................     ...............................................................  

 

E-mail: ....................................................       ................................................................  

 

Emergency Contact  

 

Name and relationship: ................................................................................................  

 

Phone: .............................................................................. 

 

 

 

 

 

 

 

In the event of an emergency, the Chabad Hebrew School has my permission to arrange  

for any necessary first-aid or care for my child. I give permission for my child/ren to take class trips with the Chabad Hebrew School. I hereby hold harmless and release Chabad Hebrew School and its 

representatives from any liability regarding thereto. I take responsibility for any damage caused by my child/ren at the Hebrew School facility. I allow photos of my family to be used for any legitimate use.  

I agree to pay the balance or make payment arrangements before the beginning of the school year for $500.00 + $50.00 (Registration and Book Fee) for a total of $550.00.  

__________________________________________________________________________  

 

Payment Options:   Make check payable to "Chabad of Peachtree City/ Hebrew school” 

_____ I am mailing One check for payment in full $550.00.or  

_____ I am mailing one check for $520 (with early registration) 

 

_____Ten postdated checks $55.00    or 

Credit Card Information:  

 

Credit Card number: ..................................................................        Expiration: .............................  

______Amount in full $550.00 or_____ in ten month $55.00 

______ Amount in full $520.00 ( if registered before July 15th)  ______ in ten months $52.00 

 

Signature of parent or legal guardian   ...........................................................................