Register Online We are currently accepting application forms for the 2021/22 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 at 201-871-1152 ex. 503. Classes will begin on Sunday September 12, 2021 CLICK HERE FOR DATES AND RATES Please note that one registration form per child is needed. There are three discount offers: Early Bird Discount: Register and complete your payment plan by June 30th to receive 10% off your child’s tuition. August 31st to receive a 5% off. Sibling Discount: 5% off of the lowest priced tuition. Bring a New Friend Discount: 10% off for the family who recommends a new family to enroll who completes their payment plan. We look forward to a wonderful year of learning and growth. Student Profile First Last Hebrew name DOB Month Jan. Feb. Mar. Apr. May Jun. Jul. Aug. Sept. Oct. Nov. Dec. Date 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Year 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2000 2010 2011 2012 2013 2014 2015 2016 School currently attending Grade entering Grade Entering Kindergarten First Second Third Fourth Fifth Sixth Third PRE K Previous Jewish education Yes No Where? Synagogue affiliated with Is child's biological mother Jewish? Any conversions or adoptions in the family? If yes, please describe: Any learning issues or disorders? (confidential) Optional: Bar/Bat Mitzvah Information (For Students in Grades 3-6) My Child's Hebrew Birthday: Month : Day Bar and Bat Mitzvah celebration dates are alloted on a first come, first serve basis. Please indicate your date preference and we will notify you of availability. Bar Mitzvah (Saturday Morning) Bat Mitzvah (Friday Night) First Preference Second Preference Third Preference Parent Information Child lives with both parents? If not, please describe situation Mail should be addressed to Mr. & Mrs. Mr. Mrs. Ms. Mother's name Mother's cell Mother's work Home phone Home address City State Zip Father's name Father's cell Father's work Father's home phone (if different) Father's address (if different) City State Zip Primary e-mail address Mother's Father's Secondary e-mail address Mother's Father's Child has a regular babysitter / nanny Babysitter / nanny's name Babysitter / nanny's cell Emergency Information Emergency Contact 1 Phone Emergency Contact 2 Phone 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. Parent Consent Form 1) I agree to follow all policies stated in the Lubavitch Hebrew School Parent Handbook and understand my responsibilities as a school parent. 2) I allow my child to attend all field trips taking place throughout the year. 3) I hereby grant permission for photography and videography of my child's activities at the Hebrew School or any activities related to Hebrew School care for public relations purposes. I agree that I am to receive no compensation for my child's appearance and that this participation confers on me no ownership rights whatsoever. 4) I give permission to Lubavitch Hebrew School in the event of a medical emergency to seek and administer medical attention for my child and if necessary, to hospitalize him/her. 5) In the event that I cannot come to Lubavitch Hebrew School to pick up my child, I hereby authorize the following people to pick up my child from school. I understand that only those individuals listed by me below will be given permission to pick up my child. Name Relationship to child 1. 2. 3. 4. 5. Names of children: I Accept Name: Initials: Please click here to place an online payment Please note that the payment plan must be completed before the first day of school. We look forward to a wonderful year of learning and growth! This page uses 128 bit SSL encryption to keep your data secure.