Student Information Child's Name* First Name Last Name Hebrew Name* Gender* MaleFemale Birth Date and Time Month Day Year at 123456789101112 Hour001020304050 MinutesAMPM What is my Hebrew Birthday? School* Grade entering* Kindergarten1st2nd3rd4th5th6th7th8th9th Previous Jewish Education* Our warm and caring staff are here to support your child and bring out the best in them. Please take the time to tell us about your child. Describe his/her talents. Tell us what helps your child learn well. We are looking forward to caring for your child and watching him/her grow!* Medical Information- Up to date with Vaccinations?* YesNo Medical Information - Any Medical Challenges? Include any allergy information.* YesNo If Yes please explain Yes, I'd like to enroll a second child! Please select Child 2 Child's Name First Name Last Name Hebrew Name Gender MaleFemale Birth Date and Time Month Day Year at 123456789101112 Hour001020304050 MinutesAMPM What is my Hebrew Birthday? School Grade entering Kindergarten1st2nd3rd4th5th6th7th8th9th Previous Jewish Education Our warm and caring staff are here to support your child and bring out the best in them. Please take the time to tell us about your child. Describe his/her talents. Tell us what helps your child learn well. We are looking forward to caring for your child and watching him/her grow!* Medical Information- Up to date with Vaccinations? YesNo Medical Information - Any Medical Challenges? Include any allergy information. YesNo If Yes please explain Parents Information Marital Status MarriedSeparatedDivorced Affiliation/Synagogue Father's Name* First Name Last Name Father's Hebrew Name Father's Occupation Father's Cell* Area Code Phone Number Father's E-mail* Mother's Name* First Name Last Name Mother's Hebrew Name Mother's Occupation Mother's Cell* Area Code Phone Number Mother's E-mail* Parent's Address* Street Address Street Address Line 2 City State / Province Postal / Zip CodePlease SelectUnited StatesAfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanThe BahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChilePeople's Republic of ChinaRepublic of ChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongoCook IslandsCosta RicaCote d'IvoireCroatiaCubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonThe GambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorthern MarianaNorwayOmanPakistanPalauPanamaPapua New GuineaParaguayPeruPhilippinesPitcairn IslandsPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint BarthelemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSomalilandSouth AfricaSouth OssetiaSpainSri LankaSudanSurinameSvalbardSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTristan da CunhaTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamBritish Virgin IslandsUS Virgin IslandsWallis and FutunaWestern SaharaYemenZambiaZimbabweOther Country Is the natural mother of the child Jewish?* YesNo Is the maternal grandmother Jewish?* YesNo Have there been any conversions or adoptions in the family?* YesNo If yes please explain All Hebrew school notifications and calendar reminders will be sent via email and/or text message. Please be sure our email address is in your primary message folder. Please also include a phone number that receives SMS and Whatsapp messages. Pictures and videos are updated to our website via Facebook. LIKE our page for instant updates! Emergency Information Emergency Contact* First Name Last Name Emergency Contact Phone* Area Code Phone Number Emergency Contact Relationship to Child* How I found the F.R.E.E. Hebrew School Our state-of-the-art Jewish youth programs are here to serve you! Please describe what you are mostly looking forward to this coming school year.* Permission Form* I agree that in case of medical emergency requiring immediate emergency care, I authorize transportation to nearest medical facility.I agree that during the course of our child[ren]'s instruction we recognize that field trips and activities other than classroom instruction will be provided by your staff and agents of the School. We understand that these additional activities are deemed necessary by the Beis Chabad and F.R.E.E. Hebrew School to provide our child[ren] with a full Jewish education and experience. I, the legal parent/guardian, authorize you and your agents to involve our child in these various trips and activities, direct you to rely upon the registration forms previously tendered for emergency contact persons for the benefit of our child[ren], authorize the administration of any medicines deemed necessary by emergency health professionals in the event of non-availability of parent/guardian, acknowledge that all known allergies or other conditions impacting the health and well-being of our child[ren] are listed above, and further release the Beis Chabad and F.R.E.E. Hebrew School and its agents from liability arising during the course of these various field trips and activities.I/we understand that my/our child[ren] may be included in photographs and video footage that may be photographed or filmed during Hebrew School. I authorize the Beis Chabad and F.R.E.E. Hebrew School to use these photos/videos to promote its programs and services in print, web, and other promotional contexts. Payment Please select that all apply* Hebrew School {Ages 5-13} Sundays 10:00-12:15 $900$100 Book Fee10% discount for each additional sibling$100 Tuition Credit for referring a new family Registration Fee* A non-refundable $150 deposit toward the total tuition will be processed as part of your registration. This is not an additional charge. $150 School Security Guard Fee per student* $150 I would like to assist a child who cannot afford Hebrew School Education. Full TuitionHalf Tuition Please Choose Payment Plan* Full Payment50% Payment September 1st and 50% Payment January 1st10 Installments Total $300.00 I would like to pay today:Full amount$300.00 minimum$ Payment Credit Card Check Credit Card We accept Visa, MasterCard, American Express, Discover Credit Card Number Security Code Name on Card1 - January2 - February3 - March4 - April5 - May6 - June7 - July8 - August9 - September10 - October11 - November12 - December Expiration Month2025202620272028202920302031203220332034 Expiration YearBilling Address Street Address City State / Province Postal / Zip CodePlease SelectUnited StatesAfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanThe BahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChilePeople's Republic of ChinaRepublic of ChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongoCook IslandsCosta RicaCote d'IvoireCroatiaCubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonThe GambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorthern MarianaNorwayOmanPakistanPalauPanamaPapua New GuineaParaguayPeruPhilippinesPitcairn IslandsPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint BarthelemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSomalilandSouth AfricaSouth OssetiaSpainSri LankaSudanSurinameSvalbardSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTristan da CunhaTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamBritish Virgin IslandsUS Virgin IslandsWallis and FutunaWestern SaharaYemenZambiaZimbabweOther Country Digital Signature* Date* Month Day Year Should be Empty: Submit This page uses TLS encryption to keep your data secure.
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