Hebrew School Registration - Chabad of Pembroke Pines

Chabad Hebrew School Logo

HEBREW SCHOOL REGISTRATION FORM

We are currently accepting application forms for the 2017-2018 school year. Please fill out ALL fields of this form. If you have any questions or concerns you'd like to discuss with us, please contact us.

Confirmation of acceptance will be acknowledged only after this registration form is reviewed and an acceptance letter is received.

Student Information

Student 1 Name*

First NameLast Name

Student 1 Hebrew Name

Student 1: Birth Date*

MonthDayYear

Student 1: Time of birth

Day timeNight time

Student 1: I can read Hebrew

None at allSomewhatWell

Student 1: Previous Jewish Education

YesNo

Please explain

Student 2 Name

First NameLast Name

Student 2 Hebrew Name

Student 2:Birth Date

MonthDayYear

Student 2: Time of birth

Day timeNight time

Student 2: I can read Hebrew

None at allSomewhatWell

Student 2: Previous Jewish Education

YesNo

Student #3 Name

First NameLast Name

Student 3 Birth Date

MonthDayYear

Student 3: Time of birth

Day timeNight time

Student 3: I can read Hebrew

None at allSomewhatWell

Student 3: Previous Jewish Education

YesNo

Parent Information

Parents

DadMom

Address

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

Home Phone Number

Area CodePhone Number

Dad Mobile Number

Area CodePhone Number

Dad E-mail

Mom Phone Number

Area CodePhone Number

Mom E-mail

I would like to receive news and updates by email

Family Information

Are there any conversion in the family?*

NoYes

Please explain

Members: please select how many children. 10% off additional children.

Please click here to become a member and join the Chabad of Pembroke Pines family.

Choose base on amount of children

$500$950$1400

Non-Members: please select how many children. 10% off additional children.

Choose base on amount of children

$600$1140$1680

Total

$0.00

Payment

Credit Card Bring/Mail a check

Postal / Zip Code

Country

* Feel free to discuss a payment plan with us. We can accomodate up to a 12 month payment plan.

** A 3% surcharge will be added to all credit card payments.