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Juda
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Juda Gallery
Chabad West Bel Air Judaism through the Arts
School Year: September - May 2025
New Student Form:
Child's Name:
*
First Name
Last Name
Child's Hebrew Name (if known)
First 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.
Child's Name
*
First Name
Last Name
Gender:
Boy
Boy
Girl
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
2024-2025 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
$250 USD
Check only if paying one-time full payment
2024-2025 Full Year Tuition
$1000 USD
Discounts
Refer a friend $50
Refer a friend $50
Full Name
Contact number
Early Bird (by July 18) $50
Early Bird (by July 18) $50
Chabad West Bel Air Member $50
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
I accept
Payment Method
Pay via Check
Pay via Check
Credit Card
Visa
MasterCard
American Express
Discover
Pay via Check
Credit Card Type
Credit Card Number
Security Code
Expiration Month
1 - January
2 - February
3 - March
4 - April
5 - May
6 - June
7 - July
8 - August
9 - September
10 - October
11 - November
12 - December
Expiration Year
2022
2023
2024
2025
2026
2027
2028
2029
2030
2031
I would like to receive news and updates by email
I would like to receive news and updates by email
Thu, October 3 2024 1 Tishrei 5785