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Register Online

Register Online


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, please contact us.

Please note that one registration form per child is needed.

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

Enrollment Form for Chabad of Lake Worth Hebrew School ~ 2017-2018 
Student Profile
First Name
Last Name
Hebrew Name
Age
DOB
School
Grade Entering
Hebrew Reading Proficiency None Somewhat Well
Previous Jewish Education Yes No
Where?


Family Information
My child is a
Are the natural father and mother of the child Jewish? Yes No
If no, please explain.
Have there been any conversions or adoptions in the family? Yes No
If yes, please explain.

Parent Information
Father's Name
Mobile
Mother's Name
Mobile
Home Phone
Address
City
Zip
Email*
* Email address allows us to communicate in the most efficient and economical manner. We do not use your address for other purposes.

Emergency Information
Emergency Contact 1
Phone
Relationship
Emergency Contact 2
Phone
Relationship


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.

 

Tuesdays 5:00 -6:30 pm Cost: $600 ($100 non-refundable registration fee will be deducted from tuition)
Payment Method Credit Card Check  Will make arrangements with the Rabbi
Total Amount to charge: Min. due: $100 non refundable registration fee (This fee will be deducted from tuition)
Credit Card Number  
Exp Date  
CVV  


Terms of Agreement

In the event of an emergency, Chabad Hebrew School has my permission to arrange for any necessary first-aid or care by a licensed physician/first-aid worker. Chabad Hebrew School has my permission to use my child's photo in its publicity materials. I have completed the Enrollment Form and agree to pay any balance according to the terms of agreement oulined above.

I Accept

Name: Initials:

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

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