New Student Registration - JewishSouthLake.com

Name of person filling out this form
First Name Last Name
Student Information
Please fill out one form per child - If you are registering more than one child the Family Information & Emergency Information may be left blank on the additional forms
Name*
First Name Last Name
Jewish Name*
Birth Date*

Month Day Year
School*
Grade Entering*
Past Jewish Education*

YesNo
Hebrew Reading Proficiancy*

NoneSome - Recognizes the Aleph-BetGood - Reads Hebrew SlowlyExcellent - Reads Hebrew Well
Knowledge of Basic Judasim*

NoneSome of the BasicsHas a Firm Grasp on the Basics
Family Information

Home Address*

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

Home Phone Number

Area Code Phone Number
Father's Name*
First Name Last Name
Father's Occupation*
Father Jewish*

YesNo
Father's Cell Phone*

Area Code Phone Number
Father's E-mail*
Mother's Name*
First Name Last Name
Mother's Occupation*
Are the child's mother and maternal grandmother all born Jewish?* If not, please reach out to [email protected] before completing this form

YesNo
Please email [email protected] before completing this form
Mother's Cell Phone*

Area Code Phone Number
Mother's E-mail*
Were there any conversions or adoptions in the family?* If yes, please reach out to [email protected] before completing this form

YesNo
Please email [email protected] before completing this form
Getting to Know You
Please answer the following questions about your family and child so that we may best serve your child's needs
Whats your vision for your child's Hebrew School experience:
What are the first 5 things that come to your mind when you think of "Judaism"
What makes you proudest about being Jewish?
If you had a Hebrew School/day school education, please describe your experience:
Is there any other information you would like to share about your family?
How can we best support you in being part of your child's Hebrew School Education?
How would you describe your child?
Does your child have any particular hobbies or passions?
Has your child had any behavioral or developmental difficulties or challenges in his/her regular school?
Is there any other information you would like to share/ have us know about your child?
Emergency Information
If you have already filled out this section for another child you may live this blank
Emergency Contact 1
First Name Last Name
Cell Phone Number

Area Code Phone Number
Emergency Contact 2
First Name Last Name
Cell Phone Number

Area Code Phone Number
Additional Info
TERMS & CONDITIONS
PARENTAL CONSENT: I hereby give consent for my child to participate in all activities of Chabad Hebrew School (CHS) both on and off site, including trips, transportation to and from trips etc., unless I advise you otherwise in writing. MEDICALCARE: In case of emergency, I hereby give permission to the physician selected by the school director, to hospitalize, to secure proper treatment for and to order injection, anesthesia, or other procedure deemed necessary for my child by an MD. Every effort will be made to contact the Parent / Legal Guardian and emergency contacts first. Should it be necessary for the wellbeing of the student to utilize outside medical or dental services, all expenses involved will be paid for by the parent. To the best of my knowledge, my child is in good health and I will notify the school if he/she is exposed to any infectious diseases. I understand that my child may be dismissed during a school day, due to illness, at the discretion of the school, and I agree to abide by the Director’s decision. IMAGES, ETC.: Permission is hereby given to use in promoting the School and in other ventures directly relating to the School (I) digital, photographic and video images or likenesses of student; audio of student; and (II) statements, articles, names, music, art, photographs, audio recordings, films and videos created by student or originating from School or from a school-related activity. INDEMNIFY & HOLD HARMLESS: I further release and agree to indemnify and hold harmless Chabad Hebrew School (CHS) and its officers, servants or assigns from any liability or claim for any loss, injury, damage or expense resulting or arising from my child’s participation in camp activities. I further agree that the use of any premises during the CHS School day is made at the risk of the registrant.
In addition, I acknowledge that the CHS administration reserves the right to reconsider the enrollment of any camper if we feel the child’s needs or level of functioning or behavior cannot be accommodated, or if the child’s conduct limits his or her ability to participate in, or to benefit fully from, the program and activities at CHS. In addition, I acknowledge that I have read and accept the financial obligations and the refund policy as stated in the application form.
I Accept*

YesNo
Full Name*
First Name Last Name
Payment Information
Tuition**: (Includes all supplies, books & snacks)

$75 Registration fee per child.

Sunday Hebrew School: $1,080.00

Sunday Hebrew School + JAZ* $1,580.00

Early Bird Discount Prior to 5/31/24:

Sunday Hebrew School: $999.00

Sunday Hebrew Scool + JAZ* $1,499.00

*JAZ - Jewish Activity Zone. A Jewish After School Program. Click Here for details.

** Chai Club members receive a 5% discount.

Scholarships are available. This form must be filled out before submitting a scholarship request. All scholarship requests MUST be submitted before August 1st. Click Here for the Scholarship Application Form.

A $75 registration fee is required with this form.
Payment Options

$75 Deposit Only (Invoice Me for the Remainder)$1155 Registration + Full Tuition (Sunday Only)$1655 Registration + Full Tuition + JAZ12 Payments of: $96.25 (Registration + Full Tuition Sunday Only)12 Payments of $137.92 (Registration + Full Tuition for Sunday + JAZ)
Yes! I Would Like to Donate to the Hebrew School Scholarship Fund

$
Total

$0.00
Yes, I'd like to donate the cost of processing this transaction by adding 3%

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:

Student Information

Family Information

Getting to Know You

Emergency Information

Payment Information

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