Registration

Address*

Additional notable Information Please let us know if there are any allergies or other important information we need to be aware of.
Parents Information
Parent's Name*

First Name Last Name
Parent's Cell*

Area Code Phone Number
Parent 2 Name*

First Name Last Name
Parent 2 Hebrew Name
Mother Jewish by:*

BirthChoice (Orthodox conversion)Choice (Other Conversion)
Parent 2 Cell*

Area Code Phone Number
E-mail*
Best way to send Hebrew School updates:*

Cell PhoneEmailHandout
I am willing to assist in school activities, please contact me
TUITION*

1200.00 for one student2280.00 for 2 students3360.00 for three students
Total

$0.00

I would like to pay today:Full amount$100.00 minimum$
Recurring Payment

I would like to set up a recurring payment. Please contact me to arrange.

Payment

Credit Card

We accept Visa, MasterCard, American Express, Discover
Credit Card Number	Security Code
Name on Card
Expiration Month	Expiration Year

Billing Address

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Country

Authorized pickup and emergency contacts
Authorized pickup
Pickup number
Emergency Contact
Emergency number
I hereby give permission for my child to be transported to and from field trips, and to participate in them in all Hebrew School activities. I understand that during the course of Hebrew School my child can be hurt. I accept the risk of possible injury and authorize any member of the Chabad of the West Side Hebrew School staff to render any necessary first aid. Furthermore, in an emergency case, I hereby authorize Sarah Alevsky, Rabbi Chayim Alevsky or another staff member to have my child taken care of by a doctor or other medical person in any way the situation calls for.
Permission Signature*
I give permission to Chabad of the West Side, Chabad Family Programs and Chabad Hebrew School of the West Side, and those authorized by Chabad, to take photographs and to make recordings of my children and my family, and to use them in original or modified form in all media now or hereafter known, with or without my name or information about me, for the promotion, public education, and/or fundraising activities of Chabad of the West Side
Media Permission*

I allow you to use my child's pictures for promotionDo not share my child's photos
Media signature*
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CHS REGISTRATION FORM 2023-2024