CHS Registration Form Please register your child below, if you have any questions please call 732-229-2424 CHS Application Family InformationFamily Name*Mother's Name*Jewish Name (if available)Father's Name*Jewish Name (if available)Mothers Email* Mother's Cell*Mother is* Jewish by birth Jewish by choice Other Please explainFathers Email* Father's Cell*Father is* Jewish by birth Jewish by choice Other Address* Street Address City StateAlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Home PhoneWork PhoneMarital Status of Parents*Child InformationLocation* Deal Rumson 1. Child Name* First Last Hebrew Name (if available)DOB*Grade Entering*2. Child Name First Last Hebrew Name (if available)DOBGrade Entering3. Child Name First Last Hebrew Name (if available)DOBGrade EnteringTuition InformationChabad Hebrew School Tuition is $600 per child. The $50 Registration Fee goes towards the Tuition Fee.Registration FeeRegistration Fee*# of Children ($50/child)1 Child2 Children3 ChildrenContact InfoPayment InfoTotal $0.00 Credit Card* American ExpressDiscoverMasterCardVisaSupported Credit Cards: American Express, Discover, MasterCard, Visa Card Number Month010203040506070809101112 Year20252026202720282029203020312032203320342035203620372038203920402041204220432044 Expiration Date Security Code Cardholder Name CommentsEnrollment AgreementTo enroll your child(ren) in Chabad Hebrew School, all forms must be completed and sent in to the school. Your application will not be processed without the required forms and fees. Full payment due at the beginning of the school year, September 9, 2018. Enrollment is considered to be for the entire scholastic year. There will be no refunds even if the child is absent due to illness, holidays, vacations and snow days, or should the parents decide to withdraw the child from the program. DISPOSITION Parent acknowledges that Chabad Hebrew School serves children who are able to function successfully in a group setting. If, in the judgment of the school's Director, the child is not able to function in a group setting, the parent may be asked to withdraw the child. In the event that the parent is request to withdraw the child, the Director will work with the parent to identify possible alternative programs suitable for the child. RELEASE OF INFORMATION AND PHOTOGRAPHS Parents allow for child(ren)'s picture to be used for internal PR mailing and website where name is not given. Parents allow for child(ren)'s photograph/name released to newspapers where last name will not be given. If not, please contact us. By submitting and initialing this form, parents accept the terms outlined above. Both parents must initial.Mother's Initials*Date* MM slash DD slash YYYY Father's Initials*Date* MM slash DD slash YYYY CAPTCHA
