Hebrew School Application Form 2022-2023

Hebrew School Application Form

5783 / 2022 - 2023
Hebrew School will be in session Monday 3:30-5:30 for ages 4-13

Bat Mitzvah Club for ages 11-12

Bar Mitzvah Club for ages 11-13
Part I: Student's Information
Child's Name:*

First NameLast Name
Hebrew Name:*
School:*
Grade:*
Age:*
Birthday*

MonthDayYear
Time of birth*

:HourMinutesAM/PM Option
Would you like to enroll a 2nd child?*
Child's Name:*

First NameLast Name
Hebrew Name:*
School:*
Grade:*
Age:*
Birthday

MonthDayYear
Time of birth*

:HourMinutesAM/PM Option
Would you like to enroll a 3rd child?*
Child's Name:*

First NameLast Name
Hebrew Name:*
School:*
Grade:*
Age:*
Birthday

MonthDayYear
Time of birth*

:HourMinutesAM/PM Option
Part II: Parents' Information
Mother's Name:*

First NameLast Name
Is Mother Jewish?*

YesNoConverted
Is Maternal Grandmother Jewish?*

YesNoConverted
Mother's Hebrew Name:*
Mother's E-mail:*
Mother's cell:*

Area CodePhone Number
Occupation:*
Work Number:*

Area CodePhone Number
Father's Name:*

First NameLast Name
Is Father Jewish?*
Father's Hebrew Name:*
Father's E-mail:*
Father's cell:*

Area CodePhone Number
Occupation:*
Work Number:*

Area CodePhone Number
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Part III: Family Information
Are Parents:*
Does your child have difficulties with general studies?*
If yes, please describe:
Were there any coversions and/or adoptions in the family?*
If yes, please specify:
Please attach conversion documents, if applicable.

Upload a File

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Are you affiliated with any synagogue?*
If yes, which one(s)?
Is there anything else you'd like to share?

Part IV: Program Information
Transportation & early drop off options

Yes, I am interested in having my child picked up from PS 290 or PS 158 and dropped off at ChabadYes, I am interested in having my child picked up from school and dropped off at ChabadYes, I am interested in having my child dropped off before 3:30 for early drop offYes, I am interested in picking up my child at 6 pm for late pick up
PS 290 & PS 158 $7/week or $10/two children - for transportation (including early drop)

Any other school $15/week or $20/ two children - for transportation (including early drop)

$5/week for early drop off (before 3:30 pm)

$20/week for late pick up (5:30-6 pm)

Part V: Tuition
Fees: $1,450 - tuition

*10% discount for each additional child enrolled (reflected in price)

** Please call Cheved Krasnjansky 917-952-1474 if you are in need of financial assistance
Please check off:*

I hereby enroll my child in Hebrew School for the school year 2022/23 and agree to pay the tuition and fees as indicated
Please Note Below: Option 2, the second installment will be charged December 1st.

Tuition Agreement:*

Hebrew School Tuition:$1,450.00

Quantity
Item subtotal:$0.00

Tuition in Two Installments of $725 each:$725.00

Quantity
Item subtotal:$0.00

Schedule a financial meeting $ Free

Enter coupon

Total $0.00

Credit Card
First Name	Last Name
Credit Card Number	Security Code
Expiration Month	Expiration Year
Billing Address
Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Should be Empty:

Hebrew School Application Form

Part I: Student's Information

Part II: Parents' Information

Part III: Family Information

Part IV: Program Information

Part V: Tuition