Printable Application Form Printable Partnership Form PLEASE NOTE: IN ORDER FOR YOUR CHILD TO ATTEND HEBREW SCHOOL FOR THE 2022-2023 PROGRAM, FULL PAYMENT OF HEBREW SCHOOL REGISTRATION IS REQUIRED BY August 17, 2022. PLEASE NOTE: IF YOU ARE SIGNING UP AND PAYING WITH CREDIT CARD ONLINE, WE HAVE INCLUDED THE CREDIT CARD USAGE FEE OF 2.5% INTO THE REGISTRATION FEE. Please complete this online form to pay by credit card* (*when paying online, total includes 2.5% credit card usage fee) and register for the Chabad Naples Hebrew School. Please note that each child must have a separate registration form. You can register online and mail your check: please print this form and include it with your check payable to Chabad Naples. Please note that each child must have a separate registration form. Confirmation of acceptance will be acknowledged only after this registration form is reviewed and an acceptance letter is received. If you have any questions or concerns you'd like to discuss with us, please call the office at 239-262-4474. Student Information Male Female Does your child have previous Jewish Education Yes No If yes, please describe: What school does your child attend? Grade entering: Is the natural mother of the child Jewish? Yes No Were there any conversions or adoptions in your family? Yes No IMPORTANT: Please provide specific details of any conversions or adoptions in your family in the space below: Are there any considerations, such as learning disorder or difficulty, the school should be aware of? (Confidential): Parent Information Emergency Contact Information Please list two contacts to be used in case of emergencies (other than your home and business numbers). CONFIDENTIAL: Does your child have any allergies or ANY medical conditions we should be aware of? If yes, please describe them and indicate special precautions or care needed. 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 trip on and beyond school properties and allow my child to be photographed while participating in Chabad Hebrew School activities. Accept Do Not Accept Initial here: Chabad Hebrew School Tuition Agreement Tuition for the Chabad Hebrew School is $975* per year per child (this includes a registration & book fee). *We have included the 2.5% credit card usage fee onto the total when paying in full online. All Hebrew School registration MUST BE PAID IN FULL prior to Hebrew School starting in September. If you are paying by check, please print the registration form and mail the completed registration with your check payable to Chabad Naples. Each child is required to have their own registration form. Payment: Payment in full of $975* (*Includes credit card usage fee) is required per child. * Denotes required field Card Type* Visa Master Card American Express Discover Card Number* Expiration Date* 01 02 03 04 05 06 07 08 09 10 11 12 2022 2023 2024 2025 2026 2027 2028 2029 2030 CVV Security Code Charge my card in the amount $ This page uses 128 bit SSL encryption to keep your data secure.