At Chabad of Greater Los Feliz

Hebrew School Registration

Full Name
First NameLast Name
Hebrew Name
First NameLast Name
Birth Date
MonthDayYear
School
Grade Entering
Hebrew Reading Proficiency
noneSomewhatWell
Previous Jewish Education
YesNo
Where
Have there been any conversions or adoptions in the family? If yes, Please explain
Please check off if each of the following family members are Jewish
Father
YesNo
Mother
YesNo
Paternal GrandFather
YesNo
Paternal Grandmother
YesNo
Maternal Grandfather
YesNo
Maternal Grandmother
YesNo
Parent Information
Father's Name
First NameLast Name
Phone Number
Area CodePhone Number

Address

Address

E-mail
Emergency Information
Emergency Contact 1
Phone
Emergency Contact 2
Phone
CONFIDENTIAL
Does your child have any allergies or other medical condition we should be aware of?
If yes, please describe them and indicate special precautions or care needed.
Payment Information - $850 annual tuition
The following is a tuition agreement for the Chabad of Greater Los Feliz Hebrew School. The agreement explains the tuition fees, payments plans and refund policies. Please read it through carefully. If paying by check or cash, full payment must be submitted to the school office before any child will be permitted to attend classes.

The tuition for the Chabad of Greater Los Feliz Hebrew School is $850 a year
Plan A: You may pay the entire amount in full with a check, cash or credit card.Plan B: You may pay the annual tuition on a monthly basis by submitting 9 checks at the beginning of Hebrew SchoolPlan C: You may use your credit card to pay the tuition on a monthly basis. Your credit card will be billed monthly from September through May. To do so please include your credit card number and expiration date at the bottom of this page.

Payment

Credit Card

Billing Address

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Country

Amounts
$850$425$85
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.
YesNo
I hereby give permission for my child to participate in all school activities, join in class and school trips on and beyond school properties.
YesNo
As a parent or guardian of this student, I hereby consent to the use of photographs/videotape taken during the course of the school year for publicity, promotional and/or educational purposes (including publications, presentation or broadcast via newspaper, internet or other media sources).
I do this with full knowledge and consent and waive all claims for compensation for use, or for damages.
Yes, I give consent for Chabad of Greater Los Feliz Hebrew School to photograph my child for school purposes and/or at school eventsNo, I do not authorize Chabad of Greater Los Feliz Hebrew School to photograph for my child for any event.
Parent Signature
Should be Empty:

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Parent Information