RETURNING STUDENT REGISTRATION FORM Parent's First Name Last Name Child 1 Grade Entering as of 09/2024 Child 2 Grade Entering as of 09/2024 Child 3 Grade Entering as of 09/2024 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 the Chabad 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, the 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 the 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! Your form is not complete without a payment plan. Hebrew School Fee: Early rate: $825 (All fees & supplies included) After August 1st: $875 $25 sibling discount Security Fee $150 (per family) Payment plans available. See below. *No child is ever turned away due to lack of funds. Pay Online For your convenience, you may pay for Hebrew School online. This page uses a secure connection and your information will not be shared with anyone. Payment options Pay in full Pay in two installments 9/1/2024 and 1/1/2025 As per our discussion, an alternative payment plan has been arranged. First Name Last Name Email Address Enter amount to be charged. This should be $50 (minimum) per child to reserve your spot, or a larger amount up to the full tuition fees. If you do not pay in full now, you will be billed the difference as per your payment plan. Address City Zip State Card Type Visa MasterCard AmericanExpress Credit Card Number Expiration Date January February March April May June July August September October November December 2025 2026 2027 2028 2029 2030 2030 2031 2032 2033 2034 CVV (what's this?) Amount: * $ *Enter amount to be charged. This should be $50 per child to reserve your spot (minimum) or a larger amount up to the full tuition fees. If you do not pay in full now, you will be billed the difference as per your payment plan. Additional Notes: This page uses 128 bit SSL encryption to keep your data secure.