Register Online - Chabad of the Five Towns
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Register Online

We are currently accepting application forms for the 2017-2018 school year. Please fill out ALL fields of this form. If you have any questions or concerns you'd like to discuss with us, please contact us. EARLY BIRD DISCOUNT UNTIL August 8.

If you would prefer to fill out this paper and mail it into our office, a PDF can be found here.

Please note that one registration form per child is needed.

No child will be turned away due to lack of funds. Please email Rabbi Meir for assistance: Rabbimeir@Chabad5Towns.com

We look forward to a wonderful year of learning and growth.

 

Registration Options
I am registering for the Sunday program 9:45-Noon.
Children, Kindergarten -  6th grade / $600
I am registering for the above Sunday Kindergarten program - No cost.
I am registering for the Brandeis 6th grade Girls Bat Mitzvah program once a month Sundays 9:45 – Noon.  - $180
I am registering for the CTeen Jr. program for Boys & Girls 7th & 8th grades 1st Sunday of each month / 10 AM  - Noon - $180

 

Student Profile
First Name
Last Name
Hebrew Name (if known)
Nickname
DOB
School Attending
Grade Entering
Was the natural mother born Jewish? Yes No
Were there any conversions or adoptions in the family? Yes No
Who?
If yes, who was the Rabbi?

Temple affiliated with (if applicable)

   
Parent Information
Address
City/Zip
Phone
Email Address
Father's (or Guardian's) Name
Father's Hebrew Name
Father's Cell
Father's Business Phone
Father's Email
Mother's (or Guardian's) Name
Mother's Hebrew Name
Mother's Cell
Mother's Business Phone
Mother's Email
   
Sibling Information
Name/s of Siblings School Siblings Attend Birth Date M/D/Y
     
Emergency Information
Emergency Contact 1
Phone
Relationship
Emergency Contact 2
Phone
Relationship

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.

As the parent(s) or legal guardian of the above child, I/we authorize any adult acting on behalf of Chabad of the Five Towns 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 attend all field trips and outings sponsored by Chabad of the Five Towns Hebre School.

I Accept

Name: Initials:

We look forward to a wonderful year of learning and growth!

 

Pay Online

For your convenience, you can now pay for Hebrew School online.

This page uses a secure connection and your information will not be shared with anyone.

Pay with- Cash Check Credit Card
Amount: $
Card Number
Name on Card
Card Type
Exp. Date
CVV#

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