New Student Registration

NEW STUDENT REGISTRATION

2019-2020 School Year
Paper Registration Form

If you would rather fill out a paper form, click here to download Chai Hebrew's Registration Packet, or email us and we will send you one in the mail.

Fill out the registration forms and send them back to us by:

Mail: Chabad of Park Slope
331 13th St., Lower Level
Brooklyn, NY 11215

or Email to: [email protected]
Online Registration
Child 1
Child's Name*

First Name Last Name
Hebrew Name*
Birth Date*

Month Day Year
Grade entering - September*
School Attending:*
Child 2
Child's Name

First Name Last Name
Hebrew Name
Birth Date

Month Day Year
Grade entering - September
School Attending:
Child 3
Child's Name

First Name Last Name
Hebrew Name
Birth Date

Month Day Year
Grade entering - September
School Attending:
Additional Information
How does your child learn best?
Are there any considerations, such as learning disorder or difficulty, that the teacher should be aware of? (Confidential)
Does your child speak and read Hebrew?*

No Poor Fair Well
What are your child’s special interests, likes or dislikes?
Any there any conversions or adoptions in the family, (please provide details)
Does your child have any allergies or other medical conditions we should be aware of? If yes, please describe them and indicate special precautions or care needed.
Emergency Contact*

First Name Last Name
Cell Phone*

Area Code Phone Number
Parent's Information
Parent 1
Name*

Prefix First Name Last Name
Hebrew Name
Birth Date

Month Day Year
Occupation
Born Jewish*

Yes No

Address*

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Phone Number*

Area Code Phone Number
E-mail*
Cell*

Area Code Phone Number
Work Number

Area Code Phone Number
Parent 2
Name*

Prefix First Name Last Name
Hebrew Name
Birth Date

Month Day Year
Occupation
Born Jewish*

Yes No

Address (if different)

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Phone Number (if different)

Area Code Phone Number
E-mail*
Cell*

Area Code Phone Number
Work Number

Area Code Phone Number
Marital status:*

Married Divorced Single Widowed
If there has been any adoptions or conversions in the family, please describe them
Additional notable Information
Permissions
*

I hereby give permission for my child(ren) to attend all field trips and outings sponsored by Chai Hebrew School. I hereby give permission for my child(ren) to be photographed in Hebrew School activities, and for the photographs to be published on the Hebrew School's website and media.
Tuition (includes $50 registration fee, books and supplies)
I would like to register my child(ren) for:*

Sundays 9:30AM-12:00PM: $900 Wednesdays 3:30-5:30PM: $900
Discounts: Please check those that apply to you.

Early Bird Registration: $50 off tuition if registered by June 17th Family Discount: 10% Discount for second and third siblings Referral Program: I was referred by an existing Chai Hebrew family
[For the Referral Program] Family that referred you:
School Pick Up
We offer school pick up at local Park Slope schools. A friendly, responsible Chai Hebrew staff member will pick up students from their school dismissal location (classroom or other meeting spot) and will safely chaperone them to Chai Hebrew on time for class.

NOTE: We require a minimum of three students from each school (and/or from each pick-up route).
I would like to register for School Pick Up

$200
Pick Up Information

School Grade School Dismissal Time
Payment

(Please note: Payments via credit card will be charged a 3% transaction fee)
Please check off one of the payment options:*

I would like to pay now in full I would like to pay half now and the balance by January 1, 2019 (head check required) I need a more flexible payment plan. I understand that my application will not be processed until a plan is in place.

I would live to pay via*

Credit Card Check or Cash

Postal / Zip Code

Country

Should be Empty:

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NEW STUDENT REGISTRATION

Child 1

Child 2

Child 3

Additional Information

Parent's Information

Parent 1

Parent 2

Permissions

Tuition (includes $50 registration fee, books and supplies)

School Pick Up

Payment