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Juda



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:
School:
Grade entering in September*
Age as of September*
Child's Name*
First Name
Last Name
Gender:
School:
Grade entering in September*
Age as of September*
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*
Full Home Address where child resides*
Street, City, State, Zip
Emergency contact (if different  than parents):
Name
Number
Check only if paying in installments
Check only if paying one-time full payment
2023-2024 Full Year Tuition
Discounts
Sponsor a Jewish child who cannot afford HSA
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.

Payment Method
Credit Card Type
Credit Card Number
Security Code
Sat, April 20 2024 12 Nisan 5784