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Registration is now open for Chabad Hebrew School of the Arts 2016/17. If your child is currently a student in the Chabad Hebrew School of the Arts, and you would like to re-register him/her, simply skip the parent, family & emergency sections unless anything has changed.

(To register more than one child, simply fill out the student & emergency information a second time after submitting the completed form once.)

Student Information

First Name

Last Name

Hebrew/Jewish Name

Date of Birth

Age
Male Female

Home Address

City
..
State.......Zip

Name of School

Grade 2016/2017

 
Does your child read basic Hebrew? Yes No
If yes: Well Fair Poor
Does your child have any difficulties with his/her general studies? Yes No
If yes, please explain:

Parent Information
Parent information is the same as last year. Skip section.

Mother's Name

Email

Home Phone


Cell Phone


Father's Name

Email

Home Phone


Cell Phone

Family Information
Family information is the same as last year. Skip section.
Were there any conversions or adoptions in your family?

If yes, please explain:

Emergency Information
Emergency information is the same as last year. Skip section.

Emergency Contact (other than parent)

Relationship to Child

Home Phone


Cell Phone


Physician or medical facility

Physician's phone

Physician's Address

Allergies (please list)

Medical Conditions (If any, please explain)

Permission for Emergency Medical Treatment


Accept Do Not Accept

Initial here:
.
Tuition Information
$450, includes registration, book fee and all supplies.
(No child will be turned away due to lack of funds)

Deposit:
A $50 non-refundable deposit is due at time of registration, per child
(to be deducted from tuition).

Discounts
:
10% discount for each additional child of the same family.

10% additional discount off your total tuition for each child of another family you successfully introduce to the Hebrew School of the Arts.

Please choose from the following 3 payment methods:
PLAN A: Pay the entire amount in full.
PLAN B: Pay the annual tuition on a monthly basis by submitting 10 post-dated checks of $40 each ($50 registration fee is due with this form), dated September through June. All checks must please be submitted before the first day of Hebrew School.
PLAN C: You may use your credit card to pay the tuition on a monthly basis. Your credit card will be billed $40 ($50 registration fee is due with this form) monthly from September through June. To do so, please include your credit card number and expiration date at the bottom of this page.
.
Payment Information
Please include with this form (via credit card or check) a $50 payment (towards tuition) to secure a space for your child.

Card Type

Name on Card

Card Number
.
Expiration Date

Security Code
Total Amount:
.

I will be mailing my check/s to
Chabad Jewish Community Center
1254 W. University Ave. #130, Flagstaff AZ 86001

Please make checks payable to:
Chabad Jewish Community Center of Flagstaff

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