Chabad of Flatbush Hebrew School Registration

Chabad of Flatbush Hebrew School Registration

School year 2022-2023
Student Information
Child's Name*

First Name Last Name
Child's Hebrew Name
If applicable
Date of Birth*

MonthDay Year
Hebrew Birthday
To calculate, please visit http://bit.do/hebrewbirthday
Gender*
Have you previously attended any Yeshiva / Hebrew school?*

YesNoOther
If yes, where and when?
Current Residence Information
Address*

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Parent Information
Father's Name*

First Name Last Name
Father Cell Phone Number

Area Code Phone Number
Father's Email Address
example@example.com
Father's Occupation
Mother's Name*

First Name Last Name
Mother Cell Number

Area Code Phone Number
Mother's Email Address
Mother's Occupation
Marital Status
Any conversions in the family?
If yes, please email us the conversion certificate to HS@chabadflatbush.org

Emergency Contact 1
Name*

First Name Last Name
Phone Number*

Area Code Phone Number
Physician and Medical Information
Name*

First Name Last Name
Phone Number

Area Code Phone Number
Insurance/Health Coverage (Company)
Please list any of the following: Current medications, Medication allergies, Food allergies, Chronic health concerns.

Tuition Information
Preferred Payment Plan
If paying via credit card, we will contact you later for the information
Tuition is $700 per year per child, plus a registration & book fee of $50, for a total of $750.

There is a $50 discount off the regular tuition for each additional child of the same family.

You may choose from the following payment methods:

PAY IN FULL: You pay the entire amount in full upon registration. This entitles you to an additional $50 discount (per family).

MONTHLY PAYMENTS: You pay the annual tuition on a monthly basis by credit card. The first installment will include the registration and book fees.

No child will be turned away due to lack of funds, Scholarships might be available. Call Mrs. Kraus for more info: 917-292-2567.
Notes
Please inform the office of any other vital information you think they may need to know about your child. Thank you.
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