Chabad Hebrew School Registration Form 2024-2025

Student Profile
Family Name*
How many children are you registering?*
Information For First Child
Name of Child*
Name Preferred To Be Called*
Child's Hebrew Name*
Birth Date*

Month Day Year
Grade Entering September 2024*
Gender*

MaleFemale
Does your child have any allergies or other medical condition?*
Does your child have any learning challenges or disorders?*
Information For Second Child
Name of Child*
Name Preferred To Be Called*
Child's Hebrew Name*
Birth Date*

Month Day Year
Grade Entering September 2024*
Gender*

MaleFemale
Does your child have any allergies or other medical condition?*
Does your child have any learning challenges or disorders?*
Information For Third Child
Name of Child*
Name Preferred To Be Called*
Child's Hebrew Name*
Birth Date*

Month Day Year
Grade Entering September 2024*
Gender*

MaleFemale
Does your child have any allergies or other medical condition?*
Does your child have any learning challenges or disorders?*
Family Information
Do Both Parents Live In The Same House?*

YesNo

Home Address*

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

Home Phone Number*
Mother's Information
Mother's Full Name*

First Name Last Name

Mother's Home Address*

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

Mother's Home Phone*
Mother's Cell*
Mother's E-mail*
Father's Information
Father's Full Name*

First Name Last Name

Father's Home Address*

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

Father's Home Phone*
Father's Cell*
Father's E-mail*
Additional Family Information
Please Mark Each Family Member That Is Jewish*

MotherFatherMaternal GrandmotherMaternal GrandfatherPaternal GrandmotherPaternal Grandfather
Are There Any Conversions or Adoptions In The Family?*

YesNo
Please Specify Who* please e-mail all information and documentation of the conversion to the director at [email protected]
Emergency Information
Emergency Contact 1*

First Name Last Name
Emergency Contact 1 Phone*
Emergency Contact 2*

First Name Last Name
Emergency Contact 2 Phone*
Doctor's Name*

First Name Last Name
Doctor's Phone*
Tuition Agreement
Hebrew School Tuition Kindergarden - 8th Grade: $800

Sibling Discount: $50 off for each additional student.

Limited scholarships available; CLICK HERE to apply for scholarship.
Please Select A Payment Plan*

Payment in full before September.Pay half before September and half on January 15.Total cost split in 9 equal monthly payments. September 2024 - May 2025
Method of payment:*

CheckCredit Card
Please mail checks to Chabad Minneapolis: 2845 Hedberg Dr., Minnetonka, MN 55305
Please submit the credit card information to use for tuition payment.

This card will only be charged (according to your selected payment plan) once your child has been accepted to Hebrew School.
Name on Card*
Card Number*
Expiration Date*
CVV*
Billing Address*
Registration Payment of $50
A $50 registration fee will be charged upon submission of your application.

If the application is not accepted, the $50 fee will be reimbursed.
Total Amount To Be Charged Today

$0.00

Payment*

Credit Card Other

Postal / Zip Code

Country

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
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Student Profile

Family Information

Emergency Information

Tuition Agreement

Registration Payment of $50