All JLE Hebrew Scholl students must fill out the form below before 1st day of Hebrew School ( all fields must be filled in below, if it doesn't apply to you please put a N/A in it but every field needs to have something written in it) Parent Information Address City/Zip Phone Father's Name Father's Occupation Father's Cell Father's Email Mother's Name Mother's Occupation Maternal Grandmother born Jewish? Mother born Jewish? Mother's Cell Mother's Email Emergency Information Emergency Contact 1 Phone Emergency Contact 2 Phone Doctor's Name Doctor's Phone Number CONFIDENTIAL: Does your child have any allergies or other medical condition we should be aware of? If yes, please describe them and indicate special precautions or care needed. Or any other comments: As the parent(s) or legal guardian of the above child, I/we authorize any adult acting on behalf of Chabad Hebrew School to hospitalize or secure treatment for my child, I further agree to pay all charges for that care and/or treatment. It is understood that if time and circumstances reasonably permit, Chabad Hebrew School personnel will try, but are not required, to communicate with me prior to such treatment. I hereby give permission for my child to participate in all school activities, join in class and school trips on and beyond school properties and allow my child to be photographed while participating in Chabad Hebrew School activities and that these pictures may be used for marketing purposes. I Accept Name: Initials: Date: Part 2 PAYMENT Parent Last Name* Parent First Name* Child #1 Last Name* Child #1 First Name* Child #2 Last Name Child #2 First Name Child #3 Last Name Child #3 Last Name Payment and Address Information. Registration/Tuition Fee one day $975.00 - Two days $1300 Lake Success Chabad family Members $775 or $975 3% percent is added for CC fees if paying by CC How will you be paying? Credit Card Check Other Name on Card Address City/State/Zip Code Phone Email Credit Card Num Exp Date Security Code Comments: We look forward to a wonderful year of learning and growth! This page uses 128 bit SSL encryption to keep your data secure.
