How many students are you registering?
1 Student
2 Students
3 Students
4 Students
Student Profile 1
Full Name
Hebrew Name
Date of Birth
School attending
Grade Entering
Please select
Kindergarten
First
Second
Third
Fourth
Fifth
Sixth
Seventh
Hebrew Reading Proficiency
Please select
None
Somewhat
Well
Previous Jewish Education
Yes
No
Where?
Have there been any conversions or adoptions in the family?
Yes
No
Student Profile 2
Full Name
Hebrew Name
Date of Birth
School attending
Grade Entering
Please select
Kindergarten
First
Second
Third
Fourth
Fifth
Sixth
Seventh
Hebrew Reading Proficiency
Please select
None
Somewhat
Well
Previous Jewish Education
Yes
No
Where?
Have there been any conversions or adoptions in the family?
Yes
No
Student Profile 3
Full Name
Hebrew Name
Date of Birth
School attending
Grade Entering
Please select
Kindergarten
First
Second
Third
Fourth
Fifth
Sixth
Seventh
Hebrew Reading Proficiency
Please select
None
Somewhat
Well
Previous Jewish Education
Yes
No
Where?
Have there been any conversions or adoptions in the family?
Yes
No
Student Profile 4
Full Name
Hebrew Name
Date of Birth
School attending
Grade Entering
Please select
Kindergarten
First
Second
Third
Fourth
Fifth
Sixth
Seventh
Hebrew Reading Proficiency
Please select
None
Somewhat
Well
Previous Jewish Education
Yes
No
Where?
Have there been any conversions or adoptions in the family?
Yes
No
Please check off if each of the following family members are Jewish
Father
Yes
No
Mother
Yes
No
Paternal Grandfather
Yes
No
Paternal Grandmother
Yes
No
Maternal Grandfather
Yes
No
Maternal Grandmother
Yes
No
Parent Information
Father's Name
Phone
Email
Mother's Name
Phone
Email
Address
City
State
Zip
Emergency Contact
Emergency Contact 1
Phone
Emergency Contact 2
Phone
CONFIDENTIAL: Does your child have any allergies or other medical condition we should be aware of? If yes, please describe them and indicate special precautions or care needed.
Payment Information - $850 annual tuition
The following is a tuition agreement for the Chabad of Greater Los Feliz Hebrew School. The agreement explains the tuition fees, payments plans and refund policies. Please read it through carefully. If paying by check or cash, full payment must be submitted to the school office before any child will be permitted to attend classes. The tuition for the Chabad of Greater Los Feliz Hebrew School is $850 a year. 10% discount for siblings!
Payment Options
Plan A: Pay with credit card. *All credit card charges are subject to a 3% processing fee*
Plan B: Pay the annual tuition on a monthly basis via ACH no Fee.
Name on Account
Routing Number:
Re-input Routing Number:
Account Number:
Re-input Account Number:
Credit Card Information
Type
Visa
MC
Amex
Discover
Number
Expiration
Code
Use contact info above
Name
Address
Zip
As the parent(s) or legal guardian of the above child, I/we authorize any adult acting on behalf of Chabad Hebrew School to hospitalize or secure treatment for my child, I further agree to pay all charges for that care and/or treatment. It is understood that if time and circumstances reasonably permit, Chabad Hebrew School personnel will try, but are not required, to communicate with me prior to such treatment.
Yes
No
I hereby give permission for my child to participate in all school activities, join in class and school trips on and beyond school properties.
Yes
No
As a parent or guardian of this student, I hereby consent to the use of photographs/videotape taken during the course of the school year for publicity, promotional and/or educational purposes (including publications, presentation or broadcast via newspaper, internet or other media sources). I do this with full knowledge and consent and waive all claims for compensation for use, or for damages.
Yes, I give consent for Chabad of Greater Los Feliz Hebrew School to photograph my child for school purposes and/or at school events
No, I do not authorize Chabad of Greater Los Feliz Hebrew School to photograph for my child for any event.
Parent Signature
Submit
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