We are currently accepting application forms for the 2021-2022 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.

We look forward to a wonderful year of learning and growth.2021-2022

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

 
Parent Information
Father's Name
Fathers Cell Number
Mother's Name
Mothers Email
Mothers Cell Number
Home Phone 
Address
City
Zip
Mothers Email*
* Email allows us to communicate in the most efficient and economical manner. We do not use your email for other purposes.
 
Emergency Information
Emergency Contact 1
Phone
Relationship
Emergency Contact 2
Phone
Relationship
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.
 
Tuition Agreement
Hebrew School is on Sunday from 10:00-12:30PM 
Tuition is $1000
Payment Schedule
 
Online Payment
This page uses a secure connection and your information will not be shared with anyone.
Cardholder's First Name
Last Name
Billing Zip
Amount
Card Number
Exp. Date
CVV
Comments
 
Terms of Agreement
I agree that in the event of an emergency, Chabad Persian Youth Hebrew School has my permission to arrange for any necessary first-aid or care by a licensed physician/first-aid worker. Chabad Persian Youth 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.
Name
Initials