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Registration

Registration

Registration Form
Name of Child:    Age:
Hebrew Name:   Birth date: 
Home Address:
Other Parent Address (if different):
Telephone:   Work:
Cell:    E-mail:
Previous Hebrew School      

Name of Day School: 

  Grade:
         
Mother's Hebrew/English Name:     Is the natural mother Jewish by birth? yes no
Father's Hebrew/English Name:     Is the natural father Jewish by birth? yes no
Are all grandparents Jewish by birth?  yes no      
Has there been a conversion or adoption in the family or extended family? If yes, please specify:  
Synagogue with which family is affiliated:    
Referred by:    
 
As the parent(s) or legal guardian of the above child, I/we authorize any adult acting on behalf of the Chabad of Scottsdale 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, the Chabad of Scottsdale 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 the Chabad of Scottsdale Hebrew School activities and that these pictures may be used for marketing purposes.
I Accept   Name:      

 I (we) hereby permit my child to participate in all school activities, join in class and school trips on and beyond school properties.

Initials:

         
Please note: Applications will not be processed without payment and a listed CC number
Cost:  $650 for shul members      $850 for non-members
Please charge my credit card

Charge full payment:

$

   

Bill me monthly through Dec. 2017

         
CC Type   Card Number
Billing Address   City, State, Zip
Charge Amount   Exp Date
CVV

 

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

For questions, call 480-998-1410 or email  Dina@chabadofscottsdale.org

 

 

 

 

 

 

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