Please note this form is for RETURNING STUDENTS ONLY! If this is your first year applying to our Hebrew School please fill out the New Student Form. Parent and Family InfoAdult #1 Name:*First NameLast NameAdult #2 Name:First NameLast NameEmergency Contact Name:*First NameLast NameEmergency Contact Cell Phone Number:*Area CodePhone NumberEmergency Contact Second Phone Number:Area CodePhone NumberStudent's InfoChild's Name:*First NameLast NameGrade (Entering into the 2022/2023 school year)*Kindergarten1st grade2nd grade3rd grade4th grade5th grade6th grade7th gradeProgram Selection:*"First Taste" Program (grades K & 1) Sunday’s, 9:30am - 12:00pm - $950Hebrew School (grades 2-7) Sunday, 9:30am - 12:00pm & Wednesday 4:30pm - 6:00pm - $1300Add another childChild #2 Name:*First NameLast NameGrade (Entering into the 2022/2023 school year):Kindergarten1st grade2nd grade3rd grade4th grade5th grade6th grade7th gradeProgram Selection:*"First Taste" Program (grades K & 1) Sunday’s, 9:30am - 12:00pm - $950Hebrew School (grades 2-7) Sunday, 9:30am - 12:00pm & Wednesday 4:30pm - 6:00pm - $1300Add another childChild #3 Name:*First NameLast NameGrade (Entering into the 2022/2023 school year):Kindergarten1st grade2nd grade3rd grade4th grade5th grade6th grade7th gradeProgram Selection:*"First Taste" Program (grades K & 1) Sunday’s, 9:30am - 12:00pm - $950Hebrew School (grades 2-7) Sunday, 9:30am - 12:00pm & Wednesday 4:30pm - 6:00pm - $1300Add another childChild #4 Name:*First NameLast NameGrade (Entering into the 2022/2023 school year):Kindergarten1st grade2nd grade3rd grade4th grade5th grade6th grade7th gradeProgram Selection:*"First Taste" Program (grades K & 1) Sunday’s, 9:30am - 12:00pm - $950Hebrew School (grades 2-7) Sunday, 9:30am - 12:00pm & Wednesday 4:30pm - 6:00pm - $1300Add another childPayment InfoAdditional Fees: $50 Registration Fee, per family $200 Security Fee, per familyAdditional Fees:$50 Registration Fee, per family$200 Security Fee, per familyI would like to pay:*Full amount todayMonthly payments automatically deducted through April 1, 2023Other $ (Needs to be $250 minimum) and the balance will be paid monthly through April 1, 2023Please contact me in regard to a scholarship application. (Scholarships are available on a case-by-case basis.)If you are applying for a scholarship request please fill out the attached form. Our Financial advisory board will only consider scholarship requests if the scholarship form is filled out with all the information that is required. Click here to fill out the scholarship request form. Once done please come back to this page to finish your registration. I would like to kindly donate to the CHS Scholarship fund :$Total$0.00I would like to pay today: Full amount$250.00 minimum $ PaymentCredit CardVisaMasterCardAmerican ExpressDiscoverCredit Card TypeCredit Card NumberSecurity CodeName on Card1 - January2 - February3 - March4 - April5 - May6 - June7 - July8 - August9 - September10 - October11 - November12 - DecemberExpiration Month2022202320242025202620272028202920302031Expiration YearBilling AddressStreet AddressStreet Address Line 2CityState / ProvincePostal / Zip CodePlease SelectUnited StatesAfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanThe BahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChilePeople's Republic of ChinaRepublic of ChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongoCook IslandsCosta RicaCote d'IvoireCroatiaCubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonThe GambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorthern MarianaNorwayOmanPakistanPalauPanamaPapua New GuineaParaguayPeruPhilippinesPitcairn IslandsPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint BarthelemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSomalilandSouth AfricaSouth OssetiaSpainSri LankaSudanSurinameSvalbardSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTristan da CunhaTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamBritish Virgin IslandsUS Virgin IslandsWallis and FutunaWestern SaharaYemenZambiaZimbabweOtherCountryTerms of agreement*I agree that in the event of an emergency, Chabad Hebrew School has permission to arrange for any necessary first-aid or care by a licenced physician /first-aid worker.Chabad Hebrew school has permission to use my child’s photo in its publicity materials.Signature:We look forward to a wonderful year of learning and growth!SubmitShould be Empty: This page uses TLS encryption to keep your data secure.