Enrollment 2025-2026 - Form - Beth Chabad Israeli Community

* Marital Status

* Are there any conversions or adoptions in the family?

If yes, Please specify

* Jewish Law mandates that we ask if the biological mother of the child is Jewish?

If No, Please specify

Primary Parent Information:

* First Name

* Last Name

Hebrew Name

* Mobile

* Email

* Address

City

Postal Code

Secondary Parent Information:

* First Name

* Last Name

Hebrew Name

* Mobile

* Email

* Address

City

Postal Code

Pricing:

Hebrew School:

Tuition $1,000.

After School:

Tuition $3,000.

***Please note that the price listed is full price before discounts and scholarships.

$50 deposit for each child. This amount will be deducted from the total payment for the course the child is enrolled in
Deposit non refundable
$50 Discount for Members
$50 Discount for siblings
Subsidy available- Please sand you request here: https://uja.smartsimple.biz/s_Login.jsp

* Would you like to apply for subsidy?

* Emergency Contacts

* Authorized to Pickup

How many children are you registering?

Student Information:

Child #1

* I would like to enroll my child to:

Chai Sunday School (Sunday, JK- Grade 6)Bar Mitzvah Club (Grade 7)Bat Mitzvah Club (Grade 6)Chai After school Monday (Grade JK-6)Chai After school Tuesday (Grade JK-6)Chai After school Wednesday (Grade JK-6)

* Child's First Name

* Child's Last Name

Child's Hebrew Name

* Gender

* Date of Birth

Month Of Birth

* Time Of Birth

* Does your child have food or drug allergies?

* If Yes, Please Specify

* School Attending

* Grade entering in September

* Has your child attended Hebrew school?

If Yes, Please Specify

* Describe his/her Hebrew reading ability

Health Card Number

* Physician's Name

* Physician's Phone Number

* Any medical condition we should be aware of?

Does the child require medication? Please Specify

Is your child up to date with his immunization?

Child #2

* I would like to enroll my child to:

Chai Hebrew School (Sunday, JK- Grade 6)Bar Mitzvah Club (Grade 7)Bat Mitzvah Club (Grade 6)Chai After School Monday (Grade JK-6)Chai After School Tuesday (Grade JK-6)Chai After School Wednesday (Grade JK-6)

* Child's First Name

* Child's Last Name

Child's Hebrew Name

* Gender

* Date of Birth

Month Of Birth

* Time Of Birth

* Does your child have food or drug allergies?

* If Yes, Please Specify

* School Attending

* Grade entering in September

* Has your child attended Hebrew school?

If Yes, Please Specify

* Describe his/her Hebrew reading ability

Health Card Number

* Physician's Name

* Physician's Phone Number

* Any medical condition we should be aware of?

Does the child require medication? Please Specify

Is your child up to date with his immunization?

Child #3

* I would like to enroll my child to:

* Child's First Name

* Child's Last Name

Child's Hebrew Name

* Gender

* Date of Birth

Month Of Birth

* Time Of Birth

* Does your child have food or drug allergies?

* If Yes, Please Specify

* School Attending

* Grade entering in September

* Has your child attended Hebrew school?

If Yes, Please Specify

* Describe his/her Hebrew reading ability

Health Card Number

* Physician's Name

* Physician's Phone Number

* Any medical condition we should be aware of?

Does the child require medication? Please Specify

Is your child up to date with his immunization?

Child #4

* I would like to enroll my child to:

* Child's First Name

* Child's Last Name

Child's Hebrew Name

* Gender

* Date of Birth

Month Of Birth

* Time Of Birth

* Does your child have food or drug allergies?

* If Yes, Please Specify

* School Attending

* Grade entering in September

* Has your child attended Hebrew school?

If Yes, Please Specify

* Describe his/her Hebrew reading ability

Health Card Number

* Physician's Name

* Physician's Phone Number

* Any medical condition we should be aware of?

Does the child require medication? Please Specify

Is your child up to date with his immunization?

Total Deposit