We are currently accepting application forms for the 2023-2024 school year. Please fill out ALL fields of this form. If you have any questions or concerns you'd like to discuss with us, please contact us.

Please note that one registration form per child is needed.

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

Enrollment Form for Chabad of Lake Worth Hebrew School ~ 2023-2024

Student 1 Profile
First Name
Last Name
Hebrew Name
Age
DOB
School
Grade Entering
Hebrew Reading Proficiency

None    Somewhat   Well
Previous Jewish Education Yes            No
Where?


Student 2 Profile
First Name
Last Name
Hebrew Name
Age
DOB 
School
Grade Entering
Hebrew Reading Proficiency None  Somewhat   Well
Previous Jewish Education Yes No 
Where?


 

Family Information
My child/children is/are 
Are the natural father and mother of the child/children Jewish? Yes No
If no, please explain.
Have there been any conversions or adoptions in the family? Yes No
If yes, please explain.

Parent Information
Father's Name
Mobile
Mother's Name
Mobile
Home Phone
Address
City
Zip
Email*
* Email address allows us to communicate in the most efficient and economical manner. We do not use your address for other purposes.

Emergency Information
Emergency Contact 1
Phone
Relationship
Emergency Contact 2
Phone
Relationship


CONFIDENTIAL: Does your child/children have any allergies or other medical condition we should be aware of? If yes, please describe them together with the child's name and indicate special precautions or care needed.

 

Tuesdays 5:00 -6:30 pm Cost: $600 per child ($100 non-refundable registration fee will be deducted from tuition)
$50 security fee (per child)
Payment Method Credit Card Check  Will make arrangements with the Rabbi
  A 3% surcharge will be added to all payments made by credit card.
Total Amount to charge: Min. due: $100 non refundable registration fee (This fee will be deducted from tuition)
Credit Card Number  
Exp Date  
CVV  


Terms of Agreement

In the event of an emergency, Chabad Hebrew School has my permission to arrange for any necessary first-aid or care by a licensed physician/first-aid worker. Chabad Hebrew School has my permission to use my child's photo in its publicity materials. I have completed the Enrollment Form and agree to pay any balance according to the terms of agreement outlined above.

I Accept

Name: Initials:

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