Hebrew School Registration - Chabad of Pembroke Pines

HEBREW SCHOOL REGISTRATION FORM

We are currently accepting application forms for the 2021-2022 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 2 Name

First NameLast Name

Student 2 Hebrew Name

Student 2:Birth Date

MonthDayYear

Student 2: Time of birth

Day timeNight time

Student #3 Name

First NameLast Name

Student 3 Birth Date

MonthDayYear

Student 3: Time of birth

Day timeNight time

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

Who converted?

FatherMotherPaternal GrandmotherMaternal Grandmother

Please explain

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

Select amount of children*

Hebrew School Scholarship Program

Total

$0.00

Payment

Credit Card Bring/Mail a check

Postal / Zip Code

Country

In these unstable times of the Covid pandemic, Chabad has lowered the price of Hebrew School tuition and is offering a payment plan.

Please choose an option below that best suits your family's needs.

Please consider sponsoring a child's tuition as well.

How would you like to pay?

One payment of $360Two payments of $180Three payments of $120

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