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Chabad Hebrew School of the Arts Registration 2017/18

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, or would like to request a printable registration form please email altie@jewishsonoma.com.

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

Student Information

 
Family Name Child's First Name

Hebrew Name

Gender Male Female
Date of Birth
What school does your child attend?
Is there anything else we should know about your child?
Have there been any conversions or adoptions in the family, if yes please explain?
Please name other children that you are registering:  
Name Age & Date of Birth
Name Age & Date of Birth
   

Parent Information

 
Father's Name Home Phone
Work Phone Email address 
Cell Occupation
Address City
State Zip Code
Jewish  Yes  No  Converted
Marital Status Married Separated Divorced
  If divorced Stepfather how long
    Stepmother how long
Mother's Name Home Phone
Work Phone Email 
Cell Occupation
Home Address(If different then above) Home City
State Zip Code
Jewish  Yes  No  Converted
 

Emergency Contact Information

 
     
Please list two contact to be used in case of emergencies  
Name 1 Relationship to child
Home Phone Cell
Name 2 Relationship to child
Home Phone Cell

 

   

Confidential

 
Does your child have any allergies, other medical conditions or special needs we should be aware of?
Yes No 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 Hebrew School of the Arts to hospitalize or secure treatment for my/our child, I/we 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 of the Arts personnel will try, but are not required, to communicate with me/us prior to such treatment. I/we hereby give permission for my/our child to participate in all school activities, join in class and school trips on and beyond school properties and allow my/our child to be photographed while participating in Hebrew School activities. I/we also understand that all liability and costs resulting from damage to property and/or personal injury caused or attributable to my/our child/children will be my/our responsibility and I/we agree to fully indemnify and save Hebrew School and it’s associates, teachers and agents harmless therefrom. I/we consent to Chabad Hebrew School of the Art’s use of our personal information and of our child/children at its discretion in pursuit of school activities.

Date Initial
 

Tuition Information and Billing

 Tuition Fee: $300 for the entire year
 
  Credit Card Check (Applications will be processed upon receiving of payment)
Amount  
Name on card    
Card # Expiration Date
 

 

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