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Registration Form

Registration Form

Complete the form below or click here to download a registration form. To Re-Register children who are in Cheder click here.
If you have any questions, feel free to contact Rabbi Wolf at 847-675-6777 or click
here for email.
Student Information
CHILD 1
Last Name
First Name
Gender
Male Female
Date of Birth
Age
Grade
School Attending
Previous Jewish education?
Yes No
If Yes please describe
Any behavioral difficulties? Yes No - If yes, please explain
CHILD 2
Last Name
First Name
Gender
Male Female
Date of Birth
Age
Grade
School Attending
Previous Jewish education?
Yes No
If Yes please describe
Any behavioral difficulties? Yes No - If yes, please explain
CHILD 3
Last Name
First Name
Gender
Male Female
Date of Birth
Age
Grade
School Attending
Previous Jewish education?
Yes No
If Yes please describe
Any behavioral difficulties? Yes No - If yes, please explain
CHILD 4
Last Name
First Name
Gender
Male Female
Date of Birth
Age
Grade
School Attending
Previous Jewish education?
Yes No
If Yes please describe
Any behavioral difficulties? Yes No - If yes, please explain
Parent Information
Address
City/State/ Zip
Home Phone
Were there any conversions or adoptions in the child's family? Yes No - If yes, please explain
Father
Title/First Name
Last Name
Hebrew Name
Date of Birth
/ /
MM / DD / YYYY format
Home Phone
Work Phone
Cell Phone
Occupation
Email
Mother
Title/First Name
Last Name
Hebrew Name
Date of Birth
/ /
MM / DD / YYYY format
Home Phone
Work Phone
Cell Phone
Occupation
Email
Emergency Information
Persons to be contacted in case of an emergency when parents cannot be reached (Please provide 2 contacts)
Emergency 1
Name
Phone #
Relationship to Child
Emergency 2
Name
Phone #
Relationship to Child
In an emergency, when you cannot reach either parent, I authorize the school to call:
Family Physician Phone
I hereby consent to the administration of Cheder Lubavitch to take whatever medical measures they deem necessary for my child in the event of a medical emergency. Parent/Legal Guardian Initials
Tuition Agreement
The following document is a tuition agreement for Cheder Lubavitch Hebrew Day School. The agreement explains the tuition fees, payments plans and refund policies. Please read it through carefully. The signed Registration Form along with full payment must be submitted to the school office before any child will be permitted to attend classes. Refunds for children withdrawing from school before the end of the school year will be granted provided that the school office is given 30 days written notice. Tuition refunds will not be granted to children withdrawing from school after April 1st. All families requesting scholarships must submit FACTS info to be eligible. A limited number of additional scholarships are available upon request; no child will be turned away for lack of funds. Additional Scholarships for extreme hardship is also available.
PLEASE CHOOSE ON OF THE FOLLOWING TUITION OPTIONS:
Divide my payments into 2 charges:
  2 postdated checks - Dated 9/1/16 and 1/1/17 - due by the first day of school
2 credit card payments - Charged on 9/1/16 and on 1/1/17 (enter credit card info below)
Divide my payments into 10 charges:
  10 postdated checks - dated the first of each month
10 credit card payments - Charged on the first of each month
Payment Information
(2.75% Service Fee on Credit Cards)
Card Type
Card Number
Expiration Date
Security Code
What's This?
Name on Card
Billing Address
Optional Comments:

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