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Educate your child... educate a generation!

Hebrew School enrollment

HEBREW SCHOOL REGISTRATION
1. Student information
Child's Name*
First NameLast Name
Hebrew Name*
Birth Date*
MonthDayYear
Does your Child have any previous Jewish education? If yes please describe.*
What School does your child attend?*
Grade entering*
Have there been any conversions or adoptions in the family? If yes please explain.*
Additional notable Information
Parents Information
Parent 1 info-name*
First NameLast Name
Cell number*
Area CodePhone Number
Email address?*

Address*

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Parent 2 info - name*
First NameLast Name
Cell number
Area CodePhone Number
Email address?

Address if different

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Marital status*
MarriedDivorcedSeprarated
Mother born Jewish*
YesConvertedNot Jewish
Converted by whom?
3. Emergency information
Emergency contact*
Phone number*
Relationship
Pediatrician
Phone number
Tuition fees (and how to save)
Tuition: $1,100
There will be an additional fee to cover security.
Early Bird special expired June 5th
Referrals: Save $100 for each family that signs up.
Late enrollment fee: $50 after July 4th.
*Please note, that no one will be turned away due to lack of funds. Please contact the office to discuss any financial considerations.
Please consider contributing towards our scholarship fund and bring the joy of Jewish education to everyone.
Payment
Tuition Cost. If you pay via CC we've added 3% charge to cover fees
$1100$1133

Payment. Please let us know if you would like to pay via check.

Credit Card Paypal Check

Postal / Zip Code

Country

Please mail your check to Chabad of Ballard 357 N 77th St Seattle Wa 98103.
Should be Empty:

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