Juda Registration

No synagogue membership required!

No child will be turned away due to lack of funds, please email[email protected] for discreet inquiries.

Student 1

Full Name

First NameLast Name

Hebrew Name

Date of Birth

MonthDayYear

School

Grade

Previous Jewish Education?

YesNo

If Yes please describe

Medical Information - Any Medical Challenges?*

YesNo

If yes please explain

Student 2

Full Name

First NameLast Name

Hebrew Name

Date of Birth

MonthDayYear

School

Grade

Previous Jewish Education?

YesNo

If Yes please describe

Medical Information - Any Medical Challenges?

YesNo

If Yes please explain

Student 3

Full Name

First NameLast Name

Hebrew Name

Date of Birth

MonthDayYear

School

Grade

Previous Jewish Education?

YesNo

If Yes please describe

Medical Information - Any Medical Challenges?

YesNo

If Yes please explain

Father's Full Name

First NameLast Name

Father's Cell Phone Number

Area CodePhone Number

Father's E-mail

Mother's Full Name*

First NameLast Name

Mother's Cell Phone Number*

Area CodePhone Number

Mother's E-mail*

Home Address

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Is the Mother, Jewish by birth?**

YesNo

*Please note: As JUDA is as a Bar & Bat Mitzvah preparation program it is bound by the policies of the central Chabad office as well as the Rabbinical policies of Israel (as are all Jewish lifecycle events).

Thereby this specific program is only open to children who's mothers were born Jewish or underwent/ are undergoing an Orthodox conversion.

Please feel welcome to join our wide variety of programs at Chabad geared to all.

Have there been any adoptions or conversions in the family (e.g., the child, parents, grandparents)?*

YesNo

If yes, please explain and indicate which synagogue the conversion took place:

Emergency Contact 1 - Full Name*

First NameLast Name

Phone Number*

Area CodePhone Number

Relation*

Emergency Contact 2 - Full Name*

First NameLast Name

Phone Number*

Area CodePhone Number

Relation*

I am registering:*

One Child - $800Two Children - $800 + $720 = $1,520Three Children - $800 + $720 + $720 = $2,240Subsidized Rate One Child - $695Subsidized Rate Two Children - $1,390Subsidized Rate Two Children - $2,085

I am registering:

One Child - $695Two Children - $695 + $660.25 = $2015.50Three Children - $695 + $660.25 + $660.25 = $2675.75

Attendance Track (please choose one):

In person Hebrew SchoolHebrew School at Home - Chaya will be in touch to arrange a timeLive zoom classes - supplies delivered to you.

I would like to make a donation to the Scholarship FundYour generous contribution will help enable local children from our community to receive the Jewish education that they so rightly deserve. Thank you for your support.

$180$360$695

Total

$0.00

I would like to pay today: Full amount$100.00 minimum $

Please charge my balance (if applicable):

8 Credit card payments - Aug-March.3 Check payments - Aug / Dec / Apr

Payment

Credit Card Check

As the parent(s) or legal guardian of the above child/ren, I/we authorize any adult acting on behalf of Chabad Religious School to hospitalize or secure treatment for my/our child/ren, 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 Religious School 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/ren to participate in all school activities, join in class and school trips on and beyond school properties and allow my/our child/ren 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 Chabad Religious School and it’s associates, teachers and agents harmless therefrom. I/we consent to Chabad Religious School’s use of our personal information and of our child/children at its discretion in pursuit of school activities. Refunds for children withdrawing from school before the end of the school year will be pro-rated up to February 1 provided that the school office is given 30 days written notice and does not include the registration fee. Tuition refunds will not be granted to children withdrawing from school after February 1. There are no refunds or credits for days missed due to illness, holidays, or family vacations.

PLEASE NOTE: Your child is not registered until you receive confirmation via email or phone call

Digital Signature*

I am willing to assist in school activities, please contact me

Student Information

Parent Information

Emergency Information

Tuition Fees

Disclaimer