Hebrew School Registration

Please fill out ALL fields of this form.
If you have any questions or concerns you'd like to discuss, please contact us.
We look forward to a wonderful year of learning and growth.
One registration form is needed per child.
Parent information
*

NEWRETURNING
Father's Full Name*
First Name Last Name
Father's Cellphone*

Area Code Phone Number
Father's E-mail*
Mother's Full Name*
First Name Last Name
Mother's Cellphone*

Area Code Phone Number
Mother's E-mail*
Home Phone

Area Code Phone Number

Address*

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Full Name of Parent Filling Out Form*
First Name Last Name
Primary contact E-mail**
Information Updates*

My information is the same from last year.I have to update some information in the text box below.
Updated Information
Please list any changes here.
Student information
Number of Children to be Enrolled:*
1) New/ Returning?*

NewReturning
1) Full Name*
First Name Last Name
1) Hebrew Name*
1) Birth Date*

Month Day Year
1) Medical: allergies or medical conditions
1) Grade Entering*
1) Hebrew Reading Proficiency*

NoneSomewhatGood
1) Has had Jewish Education before?*

YesNo
1) if yes, where?
1) Is the biological mother of the child Jewish?*

YesNo
1) Is the maternal grandmother of the child Jewish?*

YesNo
1) Were there any conversions or adoptions in your family?*

YesNo
1) Program you are registering for*
Second Child
2) New/ Returning?*

NewReturning
2) Full Name*
First Name Last Name
2) Hebrew Name*
2) Birth Date*

Month Day Year
2) Medical: allergies or medical conditions/
2) Grade Entering*
2) Hebrew Reading Proficiency*

NoneSomewhatGood
2) Has had Jewish Education before?*

YesNo
2) if yes, where?
2) Program you are registering for*
Third Child
3) New/ Returning?*

NewReturning
3) Full Name*
First Name Last Name
3) Hebrew Name*
3) Birth Date*

Month Day Year
3) Medical: allergies or medical conditions/
3) Grade Entering*
3) Hebrew Reading Proficiency*

NoneSomewhatGood
3) Has had Jewish Education before?*

YesNo
3) if yes, where?
3) Program you are registering for*
In case of Emergency
If we can't reach you.
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.
Medical Authorization*

Yes, I/We Accept
Initial*
Emergency contact 1* Name & phone
Emergency contact 2* Name & phone
Parent Volunteers
Parent involvement is key to the growth and excitement at VCHS.
Please choose at least one volunteering opportunity*

Class Parent Role - Please call me to volunteer and if I am able to help out, I most certainly willSimchat Torah Celebration - Tuesday, October 14Chanukah Gift Wrap - Sunday, December 7Tu B'shvat Fair - Sunday, February 1Hamantash Bake - Sunday, March 1Purim Party - Monday, March 2End-Of-Year Celebration - Sunday, May 17
Payment
Payment Schedule (First Child)*

Pay in full today2 Installments - First payment today and Jan 12th4 Installments - First payment today, Nov 12th, Jan 12th, and March 12th
Payment Schedule (First Child)*

Pay in full today2 Installments - First payment today and Jan 12th4 Installments - First payment today, Nov 12th, Jan 12th, and March 12th
Payment Schedule (First Child)*

Pay in full today2 Installments - First payment today and Jan 12th4 Installments - First payment today, Nov 12th, Jan 12th, and March 12th
Payment Schedule (Second Child)*

Pay in full today2 Installments - First payment today and Jan 12th4 Installments - First payment today, Nov 12th, Jan 12th, and March 12th
Payment Schedule (Second Child)*

Pay in full today2 Installments - First payment today and Jan 12th4 Installments - First payment today, Nov 12th, Jan 12th, and March 12th
Payment Schedule (Second Child)*

Pay in full today2 Installments - First payment today and Jan 12th4 Installments - First payment today, Nov 12th, Jan 12th, and March 12th
Payment Schedule (Third Child)*

Pay in full today2 Installments - First payment today and Jan 12th4 Installments - First payment today, Nov 12th, Jan 12th, and March 12th
Payment Schedule (Third Child)*

Pay in full today2 Installments - First payment today and Jan 12th4 Installments - First payment today, Nov 12th, Jan 12th, and March 12th
Payment Schedule (Third Child)*

Pay in full today2 Installments - First payment today and Jan 12th4 Installments - First payment today, Nov 12th, Jan 12th, and March 12th
Total

$0.00

Payment* Card will be charged on your selected schedule above.

Credit Card

We accept Visa, MasterCard, American Express, Discover
Credit Card Number	Security Code
Name on Card
Expiration Month	Expiration Year

Billing Address

Street Address

City

State / Province

Postal / Zip Code

Country

Should be Empty:

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Educate Your Child... Educate a Generation

Parent information

Student information

Second Child

Third Child

In case of Emergency

Parent Volunteers

Payment