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Student Registration

Student Registration

Registration is now closed for the 2017-18 school year. Please call the office for assistance or to be added to our waiting list. Call 914-693-6100 or email office@chabadrt.org  

Please fill out this form as an initial registration for Chabad Hebrew School

Confirmation of acceptance will be acknowledged only after this registration form is reviewed.

Student #1 Profile
 
Last Name
First Name
Hebrew Name
Age
DOB
Sex Male Female
Grade Entering

 

Student #2 Profile
 
Last Name
First Name
Hebrew Name
Age
DOB
Sex Male Female

Grade Entering

 

Parent Information

 
Address
City/Zip
Phone
Father's Name
Father's Occupation
Father's Work Address
Father's Cell
Father's Email
Is the biological father Jewish?
Mother's Name
Mother's Occupation
Mother's Work Address
Mother's Cell
Mother's Email
Is the biological mother Jewish?

Any Conversions in the family?
YesNo      
If yes provide details
Grandparents Information (for Nachas reports):
We would love to send updates about your child to their grandparents throughout the year

Paternal:

 
Name
Address/City/Zip
Phone Number
Email
Maternal:  
Name
Address/City/Zip
Phone Number
Email
Volunteer


I would like to volunteer at Chabad. My area of expertise:

Hebrew Reading Family Days
Maintenance Holiday Events
Other
Emergency Information
 
Emergency Contact 1
Relationship to Child
Home Address
Home Phone
Work/Cell/Pager
Additional person authorized to care for child
Relationship to Child
Home Address
Home Phone
Work/Cell/Pager
Physicians Name
Physicians Phone Number
Physician's Address
Medical Insurance Company
Group #
ID#
As the parent(s) or legal guardian of , I/we authorize any adult acting on behalf of Chabad of the Rivertowns 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.

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.



Tuition Agreement. Rates are per child - Kindergarten is Free
To view and fill in our Chai Club partner form Click here
Please check box with your choice for method of payment.
PLAN A: I am paying the entire amount in full at time of registration. (Save $125 if paid in full by May 21st)
Chai Club Partner: $1216 per child (includes $1100 tuition + $36 book and supply fee + $80 security guard fee)
Non-Partner: $1391 per child (includes $1275 tuition + $36 book and supply fee + $80 security guard fee)
 

PLAN B: $316 (Save $50 if registered by May 21st) per child payable upon registration and five automatic monthly credit card payments on the 1st of the months: September through January of:
Chai Club Partner: $180 payments (total tuition $1216 per child )
Non– Partner: $215 (total tuition $1391 per child )

 
I am submitting tuition assistance form. Click here
I would like to sponsor the education of another child for $1391

I would like to contribute $36 $72 $180 $360 other toward the Jewish education of another child. Please enter the amount here:

I am submitting a Chai Club Partner form
I am eligible for a free kindergarten tuition
 
Method of payment:
Check Credit Card
 
Payment Informationn
CC Type   Card Number
Billing Address   City, State, Zip
  Amount being charged today
  Exp Date
CVV      
         
   
 

 

I Accept

Name: Initials: Date:

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

 

 

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