Registration

Student Information
Full Name*
First Name Last Name
Hebrew Name
First Name Last Name
Birth Date* Please include approx. time of birth (am/pm for Jewish b-day purposes)

Month Day Year
at Hour Minutes
School*
Previous Jewish Education
Grade entering*

Address*

Parents Information
Father's Name*
First Name Last Name
Father's Cell

Area Code Phone Number
Father's E-mail
Mother's Name*
First Name Last Name
Mother's Hebrew Name
Mother Jewish by:*

BirthChoice
Mother's Cell*

Area Code Phone Number
Mother's E-mail*
Are there any adoptions or conversions in the family (children, parents, grandparents)* If yes, please specify and attach conversion documents Please note all conversions must be made through a registered Beth Din that is certified by the RCA

YesNo
Medical Information
Family Physcian
Name Phone number
Emergency contact
Name Relationship Phone number
Additional notable Information Please let us know if there are any allergies or other important information we need to be aware of.
Hebrew School updates and pictures are sent via Whatsapp. Your cellphone number will be used.

If you don't have whatsapp, important updates will also be messaged via text message
I am willing to assist in Chabad activities, please contact me
Payment
$1,000 Full rate or $650 subsidized rate for the year.

Rate includes book fees & all supplies. Scholarships available upon request.

Payments may be split in installments over the school year. Please specify (pay in full, 2 installments or monthly)
Tuition Fee

$1000 - Full tuition$650 - Subsidized rateScholarship request
Registration Fee Registration fee is $25, this is in addition to the tuition

$25
How would like to be charged
Total

$0.00

Payment The amount entered in the total field will be charged today

Credit Card Paypal Other

Postal / Zip Code

Country

I would like to receive news and updates by email
I am signing up my child for Hebrew School. I give Chabad of Rock Hill permission to photograph and videotape my children and use the photos and videos (without their names) for social media and advertising purposes
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