(2nd child) Hebrew School Registration 2024-25

Full Name*
First Name Last Name
Hebrew Name *
Nickname *
Birth Date*

Month Day Year
Child's E-mail
Grade Entering in the fall:*
Previous Hebrew Education: Does your child read basic Hebrew?*
Does your child speak Hebrew?*
Does your child have any difficulties with his general studies? If yes, please specify:*
*Is the biological mother Jewish? *

YesNo
*Is the biological father Jewish?*

YesNo
*Were there any conversions and/or adoptions on the mothers side of the family? If yes, please explain.*
Medical Form
Doctor's Name*
First Name Last Name
Doctor's Phone Number*

Area Code Phone Number
Medical Coverage: Insurance Company *
Policy Number: *
Allergies (if any please list)*
Medical Conditions: (If any please explain)*
Up to date with vaccinations? *

YesNo
Date of last tetanus shot:*
Permission for Emergency Medical Treatment:
As the parent(s) or legal guardian(s), I/we authorize any adult acting on behalf of the Chabad of Suffern Hebrew School to hospitalize or secure treatment for my child. I further agree to pay for all charges for that care and/or treatment. It is understood that, if time and circumstances reasonably permit, Chabad Hebrew School will try to communicate with me prior to such treatment.
Parents Signature *
*

I/we hereby give permission for my child to attend all field trips and outings sponsored by Chabad of Suffern Hebrew School.
Parent Volunteers
Parent involvement is key to the growth and excitement at CHS
Please choose at least one volunteering opportunity

Simchat Torah Celebration - Thursday, October 24Chanukah Gift Wrap - Sunday, December 22Chanukah Party - Monday, December 30Hamantash Bake - Sunday, March 9Purim Party - Friday, March 14End-Of-Year Celebration - Sunday, May 18
Payment Form
*Registrations Submitted after August 10th will be charged an additional $100.

First Taste (Kindergarten-1st Grade): $800 Yearly Tuition.

Tier II (2nd-5th grades): $1500 Yearly Tuition.

Tier III (6th & 7th grade): $1500 Yearly Tuition.

We hire and make commitments to our staff based on registrations received, and therefore we cannot refund any deposits or tuition payments.

All payments should be paid in full prior to the 1st day of Hebrew School.

* Synagogue membership is NOT required. No child will be turned away for lack of funds.*
First Taste Kindergarten

$800
First Taste 1st Grade

$800
Tier II 2nd - 5th Grade

$1500
Tier III 6th & 7th Grade

$1500
Total

$0.00