Registration
Register by August 27th and receive a special discounted price of $615 for the entire year!!! No synagogue membership required!!
Student Information
CHILD 1
Last Name
First Name
Hebrew Name
Gender
Male Female		 Date of Birth
School
Grade
Previous Jewish education?
Yes No		 If Yes please describe
Medical Information -
Any Medical Challenges?
Yes No		 If Yes please explain
 
CHILD 2
Last Name
First Name
Hebrew Name
Gender
Male Female		 Date of Birth
School
Grade
Previous Jewish education?
Yes No		 If Yes please describe
Medical Information -
Any Medical Challenges?
Yes No		 If Yes please explain
 
CHILD 3
Last Name
First Name
Hebrew Name
Gender
Male Female		 Date of Birth
School
Grade
Previous Jewish education?
Yes No		 If Yes please describe
Medical Information -
Any Medical Challenges?
Yes No		 If Yes please explain
 
Parent Information

Father
Title/First Name
Last Name
Work Phone
Cell Phone
  Email
Mother
Title/First Name
Last Name
Work Phone
Cell Phone
  Email
Parents
Address
City/State/ Zip
Home Phone
Affiliation
Have there been any adoptions or conversions in the family (e.g., the child, parents, grandparents)
Yes No		 If yes, please explain and indicate which synagogue the conversion took place
Emergency Information
Emergency 1
Name
Phone #
Relation
Emergency 2
Name
Phone #
Relation
Tuition Fees
Classes are held Sunday Morning at 10:00am - 12:00pm
Tuition: Child 1 $695 • Second Child $675 • Third Child $650 • (by Aug. 27th $615 per child)
5% Discount for additional child.
15% Discount for a friend referral | Friend Name
Before August 27th $615 Per child
Payment Information
Please Choose Payment Plan
Checks should be sent to Chabad of Fremont 220 Yerba Buena Pl., Fremont CA 94536
I would like to assist a child who cannot afford Hebrew School Education.
Disclaimer
Please note: Your child is not registered in the Chabad Hebrew School until you receive an acceptance confirmation phone call or email.
I heard about the Chabad Hebrew School from
Digital Signature
 

 

Registration Form 
 


STUDENT INFORMATION
Registrant 1
First Name   Last Name
   
Email address    Phone number  
How did you hear about us?    

 

Registrant 2
First Name   Last Name
Email address    Phone number  
       
 

PAYMENT OPTIONS

Full tuition (per student): $65.00
 Includes registration fee, Student Handbook, Wallet Reminder Card, Home Emergency Plan & 2-year certification 

 

Please choose one of the following payment Method:

Credit Card  Check

Credit Card Merchant Services

All checks shoud be made out to: Chabad of Fremont and sent in before January 5th.

Mailing Address: 38054 Dundee Common, Fremont, CA 94536 or bring it to the course.

Credit Card Information:
Name on card   Card Type  
Charge Amnt.   Card Number
Exp. Date      CVV Code   3 digits on back of card

Please click submit only once.   

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