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Registration Form

Registration Form

Dear Parents,

Hebrew school registration for 2017-18 school year is now open.

Please fill out ALL fields in this form. Please note that one registration form per child is needed. If you have any questions or concerns please contact us at chabadnoe@gmail.com

Looking forward to a wonderful year of learning and growth!
Your dedicated teachers,

Mora Leah

Morah Shternie

Rabbi Gedalia

Student Profile
 
First Name
Last Name
Hebrew Name
DOB
School
Grade Entering
Hebrew Reading Proficiency None Somewhat Well
Previous Jewish Education Yes No
Where?
Parent Information
 
Father's Name
Father's Occupation
Father's Cell
Mother's Name
Mother's Occupation
Mother's Cell
Home Phone
Address (This must match credit card billing address)
City
State
Zip
Email Address
Emergency Information
 
Emergency Contact 1
Phone
Emergency Contact 2
Phone
Payment Information (Deposit $50, Full Payment $650)
 
Cardholder First Name
Cardholder Last Name
Name on Credit Card
Credit Card Number
CVV
Exp Date
Amount to Charge



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.

As the parent(s) or legal guardian of the above child, I/we authorize any adult acting on behalf of Chabad Noe Valley & Gan Noe 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. 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

Name: Initials:

We look forward to a wonderful year of learning and growth!

 

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