Printed from ChabadTucson.com

Application

Application

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

Please note that one registration form per child is needed.

We look forward to a wonderful year of learning and growth.
 

Student Profile
 
First Name
Last Name
Hebrew Name
DOB
 School 
Grade Entering as of 09/13  
 

Hebrew Reading Proficiency

None Somewhat Well
Previous Jewish Education Yes No
Where?

 

Parent Information
 
Father's Name
Phone
Mother's Name
Phone
Home address
City
State
Zip
Email Address
 

Emergency Information
In case of illness or injury of a child at school, every effort will be made to contact the parent or guardian
Emergency Contact 1
Phone
Cell Phone
Emergency Contact 2
Phone
Cell Phone

 


Please check one:

Registration $60 per child

Sunday only Hebrew School

 Full week school

Total Payment Due

Synagogue membership is NOT required. Payment plan available. No child will be turned away for lack of funds.

CONFIDENTIAL: Does your child have any allergies or other medical condition we should be aware of? If yes, please describe them and indicate special precautions or care needed.

As the parent(s) or legal guardian of the above child, I/we authorize any adult acting on behalf of Chabad Hebrew School to hospitalize or secure treatment for my child, I further agree to pay all charges for that care and/or treatment. It is understood that if time and circumstances reasonably permit, Chabad Hebrew School personnel will try, but are not required, to communicate with me prior to such treatment. I hereby give permission for my child to participate in all school activities, join in class and school trips on and beyond school properties and allow my child to be photographed while participating in Chabad Hebrew School activities and that these pictures may be used for marketing purposes.

I Accept

Name: Initials:
 

 

Secure This page uses 128 bit SSL encryption to keep your data secure.