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
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
Emergency Contact 2
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:

Last Name*
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?

Name on Card      
Address   City/State/Zip Code
Phone   Email
Credit Card Num   Exp Date
Security Code      

We look forward to a wonderful year of learning and growth!