Hebrew School Registration form - ChabadSouthside.com

Address

Father's E-mail
Mother's email
Emergency contact
Name

First Name Last Name
Relationship
Phone Number

Area Code Phone Number
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 $600.00 + $50.00 (Registration and Book Fee) for a total of $650.00 or $620 for registrations completed before August 15th.
Signature*

First Name Last Name
Payment options
My prefered form of payment*

Payment

Credit Card

Billing Address

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Country

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Family information