Hebrew School

REGISTRATION FORM

***** One form per child please *****

Tuition price: $700 for the year (10% off each additional sibling)

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Section 1 - Child's Information

Child's Name:

Child's Jewish Name:

Gender: 

Date of Birth (with year): Approx. time of the day:

Age: Grade:

Child's Address:

Child's Phone Number:

 

Previous Hebrew School or Day School Attendance:

 

 

Section 2 - Family Information

Mother's Name:

Mother's Hebrew Name:

Mother's Address:

Mother's Phone Number:

Mother's Email Address:

**********************

Father's Name:

Father's Hebrew Name:

Father's Address:

Father's Phone Number:

Father's Email Address:

************************

Family Synagogue Affiliation (if any)

 

 

Section 3 - Emergency Information

Emergency Contact:

Contact's Phone Number:

Special needs [allergies or any other medical issues]

Special needs [any psychological or behavioral issues]

 

Section 4 - Payment information

Please register my child for Chabad of the Berkshires Hebrew School program

Total tuition:

Payment Method:

Credit card

Card type:

Name on card:

Number on card

Expiration date

CVN

Billing address

I will mail a check to 17 West Street, Lenox, MA 01240