HEBREW SCHOOL REGISTRATIONTo register your child simply complete the registration form below. Student InformationChild's Name* First Last Date of Birth* Month Day Year Gender* Male Female Have you previously attended any Yeshiva / Hebrew school?* Yes No Current Residence InformationAddress* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Parent InformationFather's Name* First Last Father's Cell Phone NumberFather's Email Address Mother's Name* First Last Mother's Cell Phone NumberMother's Email Address Marital Status Married Divorced Single Parent Any conversions in the family? No Yes, Mother Yes, Father Conversion InformationNote: Please email any and all paperwork associated with the conversion to rabbim@waysideshul.orgWho was the rabbi that helped the conversion process? With which Beth-Din (Jewish Court) was the conversion done with? What was the date of the conversion? Emergency ContactEmergency Contact #1 Name* First Last Emergency Contact #1 Phone*Emergency Contact #2 Name First Last Emergency Contact #2 PhonePhysician and Medical InformationPhysician's Name* First Last Physician's Phone*Insurance/Health Coverage (Company) Please list any of the following: Current medications, Medication allergies, Food allergies, Chronic health concerns.Tuition InformationTuition for Chabad Hebrew School is $650.00 per year per child (registration & book fee included). There is a 10% discount off the regular tuition for each additional child of the same family. [for example, a family with two enrolled children will pay $650 for the 1st child and $585 for the 2nd, for a total of $1,235]. You may choose from the following payment methods. PAY IN FULL: You pay the entire amount in full upon registration. This entitles you to an additional $50 discount (per family). MONTHLY PAYMENTS: You pay the annual tuition on a monthly basis either by submitting post-dated checks, or by credit card. Please note: first installment is doubled, for the first and last months. [for example, a family with 2 children paying with monthly payments: Total tuition due is $1,235. Divided by 10 months = $123.50. First installment (for September and June) will be $247, followed by an additional eight installments (October through May) of $123.50. All checks must be submitted before the first day of Hebrew School. No child will be turned away due to lack of funds, Scholarships are available. Call us for more info: 732-433-0800Preferred Payment Plan* Pay in Full via Credit Card Pay in Full by Check Monthly Payments via Credit Card (First Installment Will Be For First 2 Months Up-front) Monthly Payments by Check (First Installment Will Be For First 2 Months Up-front) Do you already have another child registered?No, This is the first child I am registeringYes, I already have another child registered, please apply my 10% discountDo you already have another child registered?No, This is the first child I am registeringYes, I already have another child registered, please apply my 10% discountTotal $0.00 Credit CardCard Details Cardholder Name NotesPlease inform us about any other vital information you think we may need to know about your child. Address 1 Poplar Place Ocean, NJ 07712 Phone P. (732) 433-0800 E-Mail rabbim@chabadgmc.com
