Registration 2024-2025

CHS REGISTRATION FORM 2024-2025
Parents Information
Parent's Name*

First Name Last Name
Parent E-mail*
Parent's Cell*

Area Code Phone Number
Parent 2 Name*

First Name Last Name
Parent 2 E-mail*
Parent 2 Cell*

Area Code Phone Number

Address*

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Mother Jewish by:*

BirthConversion
Is the child adopted?*

YesNo
Please upload files for conversion*
Please upload files on adoption.*
Student Information
Full Name*

First Name Last Name
Hebrew Name

First Name Middle Name
Birth Date*

Month Day Year
For calculating Hebrew Birthday: Approx time of day child was born
Grade entering*
School*
Previous Jewish Education, if any
I'd like to register a second child

YesNo
2nd child
Full Name, 2nd child

First Name Last Name
Hebrew Name, 2nd child

First Name Middle Name
Birth Date, 2nd child,

Month Day Year
Approx time of day born, 2nd child
School
Grade entering,2nd child,
Previous Jewish Education, 2nd child
I'd like to register a third child

YesNo
3rd Child
Full Name, 3rd child

First Name Last Name
Hebrew Name, 3rd child

First Name Middle Name
Birth Date, 3rd child

Month Day Year
Approx time of day born, 3rd child
School, 3rd child
Previous Jewish Education, 3rd child
Grade entering, 3rd child
Additional notable Information Please let us know if there are any allergies or other important information we need to be aware of.
I would like to volunteer for school activities, chaperoning trips, and/or have a special skill or talent I can add to the class.
Authorized pickup and emergency contacts
Authorized pickup
Pickup number
Emergency Contact
Relationship to student
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 Shayna Sapochkinsky or Eliyahu Sapochkinsky 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 promotionPlease reach out to me regarding this
TUITION BREAKDOWN:

FULL TUITION 1ST CHILD: $1200.00
2ND CHILD: $2280.00
3RD CHILD $ 3360.00

RECURRING PLAN: $120 PER MONTH
OR WHATEVER BREAKDOWN WORKS FOR YOU

FINANCIAL ASSISTANCE PLAN
PLEASE REACH OUT TO ELIYAHU
PLEASE CHOOSE

FULL PAYMENT - CREDIT CARDRECURRING PAYMENT - CREDIT CARDZELLECHECKFINANCIAL ASSITANCE PLAN
FULL TUITION*

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

$0.00
CLICK HERE TO SET UP RECURRING PAYMENT FOR TUITION
THEN RETURN TO THIS PAGE AND SUBMIT THE FORM
CHECK: CHABAD FAMILY PROGRAMS

MEMO: HEBREW SCHOOL

ADDRESS: 170 WEST 97TH STREET, NEW YORK, NY 10025
OUR ZELLE NAME IS: CHABAD FAMILY PROGRAMS OF THE WEST SIDE INC.

EMAIL IS [email protected] -

MEMO; HEBREW SCHOOL

PLEASE SEND ZELLE BEFORE SUBMITTING THIS FORM
PLEASE SEND AN EMAIL TO [email protected]
TO DISCUSS THE BEST TUITION PLAN

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

City

State / Province

Postal / Zip Code

Country

Should be Empty:

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CHS REGISTRATION FORM 2024-2025

Parents Information

Student Information

2nd child

3rd Child

Authorized pickup and emergency contacts