Printed from ChabadMinneapolis.com

Registration Form

Registration Form

Online Quick Registration!

Note: Please use a separate form for each child. If you would like to register more than one child, hit the back button after you submit the form and change the necessary information.

Once your registration is received you will be contacted to complete the registration. $50 deposit deducted from total tuition fees is due at registration

Student Profile
 
Family Name
Name of Child prefers to be called
DOB
Age
Grade Entering Sept 2017
Male Female  
Home Address
Home Phone

Does your child have any allergies or other medical condition we should be aware of?  
Any considerations, such as learning disorder or difficulty, the school should be aware of?
Family Information
 
Father's Name
Father's Phone
Father's Cell
Father's Email
   
Mother's Name
Mother's Phone
Mother's Cell
Mother's Email
   
Please fill in for each of the following family members yes or no if they are Jewish:
Father Mother
Paternal Grandmother Paternal Grandfather Maternal Grandmother Maternal Grandfather

Were there any conversions or adoptions in the family?

If yes please specify who: please e-mail all information and documentation to the director at Rochi@ChabadMinneapolis.com


Emergency Information
 
Emergency Contact 1
Phone
Emergency Contact 2
Phone
Doctor's Name
Doctor's Phone Number
Tuition Agreement
Registration Fee: $50 (deducted from total tuition)
Tuition for the year, per child: $550 + $50 book fee
Discount: limited scholarships available.

Please check box with your choice for method of payment.
Prepayment in full before September.

Pay ½ of tuition before September, and ½ by January 15.

Total cost split by 10 equal monthly payments.
 
 
 

 

Method of payment:
Check
Credit Card
 
Please mail checks to Chabad Minneapolis: 2845 Hedberg Dr., Minnetonka, MN 55305
 
 
Registration Payment
CC Type   Card Number
Billing Address   City, State, Zip
Charge Amount   Exp Date
security code



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:

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

 

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