Juda - Form - Chabad West Bel Air

Chabad West Bel Air Judaism through the Arts
School Year: September 10 - May 20

New Student Form:

Child's Name:*

First Name

Last Name

Gender:

BoyGirl

School:

Grade entering in September*

Age as of September*

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.

Child's Name*

First Name

Last Name

Gender:

Boy

Girl

School:

Grade entering in September*

Age as of September*

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.

Parent Information

Father's Name*

First Name

Last Name

Father's E-mail*

Father's Cell*

Area Code

Phone Number

Father's Instagram Name

Mother's Name*

First Name

Last Name

Mother's E-mail*

Mother's Cell*

Area Code

Phone Number

Mother's Instagram Name

Parents' Marital Status*

Married, Separated, Divorced

Mother's Religion*

Father's Religion*

Any conversions in the family? If yes, please specify

Full Home Address where child resides*

Street, City, State, Zip

Emergency contact (if different than parents):

Name

Number

Check only if paying in installments

2023-2024 Tuition paid out in 4 installments ($250 upon registering plus 3 more automatic payments of $250 on September 1, October 1, November 1, & December 1)

$250 USD

Check only if paying one-time full payment

2023-2024 Full Year Tuition

$1000 USD

Discounts

Refer a friend $50

Full Name

Contact number

Early Bird (by Aug 8) $25

Chabad West Bel Air Member $50

Sign me up for membership

Sponsor a Jewish child who cannot afford HSA

$1000

Other amount

Total Charge

Total Amount

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 hereby give permission for my child to participate in all school activities, join in class and school trips on and beyond school properties and allow my child to be photographed while participating in Chabad Hebrew School activities and that these pictures may be used for marketing purposes.

I accept

Payment Method

Pay via Check

Credit Card

Credit Card Type

Credit Card Number

Security Code

Expiration Month

Expiration Year

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