Chabad Hebrew School Registration 2024-2025

Number of children*

Name*

Child First Name Child Last Name

Hebrew & Nickname*

First Name Nickname

Gender*

MaleFemale

Birth Date*

Month Day Year

Student Phone Number

Area Code Phone Number

Student Email

School*

Grade Entering*

Previous Jewish Education*

Chabad Hebrew SchoolNone

Hebrew Reading Proficiency*

Does student have any General Studies learning difficulties? If yes, please describe.*

Yes, I want to register for Chabad Hebrew School*

Chabad Hebrew School

Name 2*

Child First Name Child Last Name

Hebrew & Nickname 2*

First Name Nickname

Gender 2*

MaleFemale

Birth Date 2*

Month Day Year

Student 2 Phone Number

Area Code Phone Number

Student 2 Email

School 2*

Grade Entering 2*

Previous Jewish Education 2*

Chabad Hebrew SchoolNone

Hebrew Reading Proficiency 2*

Does student 2 have any General Studies learning difficulties? If yes, please describe.*

Yes, I want to register for Chabad Hebrew School*

Chabad Hebrew School

Name 3*

Child First Name Child Last Name

Hebrew & Nickname 3*

First Name Nickname

Gender 3*

MaleFemale

Birth Date 3*

Month Day Year

Student 3 Phone Number

Area Code Phone Number

Student 3 Email

School 3*

Grade Entering 3*

Previous Jewish Education 3*

Chabad Hebrew SchoolNone

Hebrew Reading Proficiency 3*

Does student 3 have any General Studies learning difficulties? If yes, please describe.*

Yes, I want to register for Chabad Hebrew School*

Chabad Hebrew School

Name 4*

Child First Name Child Last Name

Hebrew & Nickname 4*

First Name Nickname

Gender 4*

MaleFemale

Birth Date 4*

Month Day Year

Student 4 Phone Number

Area Code Phone Number

Student 4 Email

School 4*

Grade Entering 4*

Previous Jewish Education 4*

Chabad Hebrew SchoolNone

Hebrew Reading Proficiency 4*

Does student 4 have any General Studies learning difficulties? If yes, please describe.*

Yes, I want to register for Chabad Hebrew School*

Chabad Hebrew School

Address*

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

Home Phone Number*

Area Code Phone Number

Parent/Guardian Marital Status*

Parent 1 (or Guardian) Name*

First Name Last Name

Parent 1 Type*

Parent 1 Occupation*

Parent 1 Business Phone*

Area Code Phone Number

Parent 1 E-mail*

Parent 1 Cell Phone*

Area Code Phone Number

Parent 2 (or Guardian) Name*

First Name Last Name

Parent 2 Address*

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

Parent 2 Home Phone Number*

Area Code Phone Number

Parent 2 Type*

Parent 2 Occupation*

Parent 2 Business Phone*

Area Code Phone Number

Parent 2 E-mail*

Parent 2 Cell Phone*

Area Code Phone Number

Father's Religion*

Mother's Religion*

Is child adopted or born through surrogacy*

NoYes

Synagogue Affiliation*

Were there any conversions or adoptions in the family (including parents and grandparents)?*

NoYes

1. Child/ren may be picked up from Hebrew School by:

Name and Relationship

2. Child/ren may be picked up from Hebrew School by:

Name and Relationship

Emergency Contact Name*

First Name Last Name

Phone Number*

Area Code Phone Number

Address*

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

Relationship*

Family Physician*

First Name Last Name

Phone Number*

Area Code Phone Number

Medical Insurance Company*

Insurance Group Number

Primary Insured Policy Number*

Child Policy Number*

Child 2 Policy Number*

Child 3 Policy Number*

Child 4 Policy Number*

MEDICAL RELEASE

I hereby give consent to the administration of Chabad Hebrew School and Chabad Lubavitch of Idaho to take whatever medical measures they deem necessary, at my expense, for my child in the event of a medical emergency. I understand that, when possible, every effort will be made to contact parent/guardian or emergency contact before Chabad Hebrew School/Chabad Lubavitch of Idaho will undertake such decision.

COVID-19 AGREEMENT* At the moment, we do not anticipate any COVID-19 restrictions or protocols.

I will follow any and all current and potential health & safety protocols regarding Covid-19 and affirm that I assume all risk and will not hold Chabad Lubavitch of Idaho or Chabad Hebrew School or its staff, volunteers and attendees liable if exposed to Covid-19.

Signature of Parent or Guardian*

Date & Time*

Month Day Year

at Hour Minutes

My child/ren is permitted to be given Children's Tylenol, Motrin or similar:*

YesNo

Is your child/ren allergic to any medications?*

NoYes

Please specify medical allergies.

Is your child/ren allergic to any foods?*

NoYes

Please specify food allergies.

Is your child/ren up to date on all immunizations?*

YesNo

Does your child/ren have a medical, developmental or emotional condition that camp should be aware of?*

YesNo

Please specify condition(s).*

The purpose of securing background and developmental information about your child is to help our staff better understand your child. Your child’s success at Chabad Hebrew School is a responsibility we share.

Please complete the following questionnaire.

Please specify previous group experience(s) in which your child has participated.*

Please describe your child's strengths and/or weakness (physical, emotional, intellectual):*

What are your child's particular strengths and talents?*

Favorite Activity:

Please specify previous group experience(s) in which your child 2 has participated.*

Please describe your child's strengths and/or weakness (physical, emotional, intellectual) 2:*

What are your child 2's particular strengths and talents?*

Child 2 Favorite Activity:

Please specify previous group experience(s) in which your child 3 has participated.*

Please describe your child's strengths and/or weakness (physical, emotional, intellectual) 3:*

What are your child 3's particular strengths and talents?*

Child 3 Favorite Activity:

Please specify previous group experience(s) in which your child 4 has participated.*

Please describe your child's strengths and/or weakness (physical, emotional, intellectual) 4:*

What are your child 4's particular strengths and talents?*

Child 4 Favorite Activity:

What other information is important to your child/ren's success?

I hereby permit my child to participate in all school activities, and to join in class and school trips on and beyond school properties and use any transportation selected by the Chabad Hebrew School.

Permission is hereby given to use in promoting the school and in other ventures directly relating to the school (i) digital, photographic and video images or likenesses of student; audio of student; and (ii) statements, articles, names, music, art, photographs, audio recordings, films and videos created by student or originating from Chabad Hebrew School or from a school-related activity.

I further release and agree to indemnify and hold harmless Chabad Lubavitch of Idaho, Chabad Jewish Center, Chabad Hebrew School and its officers, servants or assigns from any liability concerning my child’s involvement in Chabad Hebrew School and further agree that the use of any premises during the Chabad Hebrew School day is made at the risk of the registrant.

I understand and agree that Chabad Hebrew School reserves the right to dismiss, in its sole discretion, any student whose condition, conduct, influence or behavior is deemed unsatisfactory or detrimental to the best interests of Chabad Hebrew School or fellow students or who violates Chabad Hebrew School rules and regulations. In the event of dismissal, tuition paid will be forfeited.

I have read and agree to all of the terms and conditions in this Application Form. I am including a non-refundable $75.00 registration fee per student along with submission of this form.

Signature of Parent or Guardian*

Date & Time*

Month Day Year

at Hour Minutes

Volunteering

I would like to volunteer with teaching.I would like to volunteer with transportation.I would like to volunteer for extra curricular activities and events.I would like to volunteer with set-up, snack prep and clean-up.I would like to volunteer with security / door and premises monitoring.

Comments:

Payment terms are a $75.00 non-refundable registration fee per student.

Tuition terms will be decided prior to acceptance and will take into account multiple students from the same household, scholarship requests, discounts applied and payment plans. Click here for Chabad Hebrew School tuition rates and information.

Please Note: Hebrew School tuition is not a monthly or class-based fee, but a one-time charge. As a courtesy, we offer installment payment plans. Chabad does not refund tuition for classes missed.

Payment Options*

Upon acceptance, please charge my card the full amount of tuition.Upon acceptance, please charge my card in two installments.Upon acceptance, I will send a check for the full amount of tuition. Tuition check must be received before the start of the school year.I would like to make other payment arrangements. Please contact me.

Your card will be charged a non-refundable $75 registration fee per student. Upon acceptance to Chabad Hebrew School, you will be billed the full tuition amount (as per arrangements above) and your registration fee will be applied to your balance. In the event your child is not accepted, your registration fee will be refunded.

Scholarship

I would like to apply for a scholarship. Please contact me.

Total

$0.00

Yes, I'd like to donate the cost of processing this transaction by adding 3%

Payment

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

Registration

Registration Form

MEDICAL AND EMERGENCY CONTACT INFORMATION

BACKGROUND AND DEVELOPMENTAL INFORMATION

Parental Consent

VOLUNTEERING

COMMENTS

FINANCIAL ARRANGEMENTS

PAYMENT