Register

REGISTER BEFORE AUGUST 15 FOR AN EARLY-BIRD DISCOUNT

No synagogue membership required!

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

Micro Form: If your child has attended JUDA or Gan Izzy, Register Here.

Parent 1 Full Name

First Name Last Name

Parent 1 Cell Phone Number

Area Code Phone Number

Parent 1 E-mail

Parent 2 Full Name

First Name Last Name

Parent 2 E-mail

Parent 2 Cell Phone Number

Area Code Phone Number

Home Address

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

Is the Mother, Jewish by birth?**

YesNo

* Kindly take note that JUDA operates as a Bar & Bat Mitzvah preparation program, and as such, it adheres to the policies of the central Chabad office and the Rabbinical policies of Israel, which are applicable to all Jewish lifecycle events.

Hence, this particular program is only available to children whose mothers were born Jewish or have undergone/are undergoing an Orthodox conversion.

However, we warmly invite everyone to participate in the diverse range of programs at Chabad, which cater to individuals from all backgrounds.

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:

Student 1

Full Name*

First Name Last Name

Hebrew Name

Date of Birth*

Month Day Year

School

Grade

Previous Jewish Education?

YesNo

If Yes please describe

Medical Information - Any Medical Challenges? *

YesNo

If yes please explain

I'd like to register a second child

Yes

Student 2

Full Name

First Name Last Name

Hebrew Name

Date of Birth

Month Day Year

School

Grade

Previous Jewish Education?

YesNo

If Yes please describe

Medical Information - Any Medical Challenges?

YesNo

If Yes please explain

Emergency Contact 1 - Full Name*

First Name Last Name

Phone Number*

Area Code Phone Number

Relation*

Emergency Contact 2 - Full Name*

First Name Last Name

Phone Number*

Area Code Phone Number

Relation*

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

I am registering:*

One Child - $985Two Children - $886 + $960= $1,945Subsidized Rate One Child - $750Subsidized Rate Two Children - $750 + $731 = $1481

I am registering:

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

I would like to contribute towards the Scholarship of a child in need Your contribution enables Chabad to subsidize the tuition of a child in need, gifting them a Jewish experience they so rightly deserve.

$180$360$695

Will you be paying in Installments?*

YesNo

Please charge my balance (if applicable):

4 Credit card payments - Sep-Dec.3 Check payments - Sep / Nov / Dec

Total

$0.00

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

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 of Fremont 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, Chabadof Fremont 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 of Fremont and it’s associates, teachers and agents harmless therefrom. I/we consent to Chabad of Fremont use of our personal information and of our child/children at its discretion in pursuit of school activities. Tuition refunds will not be granted to children withdrawing from school. There are no refunds or credits for days missed due to illness, holidays, or family vacations. I understand that if my child behaves dangerously or bullies another child they will be removed from the program.

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

Digital Signature*

Parent Information

Student Information

Emergency Information

Tuition Fees

Disclaimer