Alef Alef 2019-2020 We are excited to welcome you to Alef Alef! Please fill out the form below carefully. When you press submit, this form will be sent to our administration office. Register Online Please fill out the form below: Student 1* Student 2 Student 3 Student's Full Name* Student's Full Name Student's Full Name Hebrew Name* Hebrew Name Hebrew Name School Attending* School Attending School Attending Entering Grade* Entering Grade Entering Grade General Information* What goals would you like to see your child/ren accomplish in Alef Alef?* Briefly describe your child/ren's personality* Previous Jewish Education Yes No If yes, where? Hebrew reading proficiency None Somewhat Well Fees* Sunday Class: $650.00/Child Private Tutoring: $65/at Home $50/at Chabad DISCOUNTS: Sibling Discount: 10% Parents' Information Parents' Status Married Widowed Divorced Separated Home Phone Home Address City State Zip Father's Full Name Work Phone Cell Phone Email Mother's Full Name Work Phone Cell Phone Email Comments Emergency Contact Information* Contact 1* Phone* Relationship to child* Contact 2* Phone* Relationship to child* Family Physician* Phone* Are there any medical concerns that your child's teacher should be aware of?* List all persons authorized to pick-up camper from campus.* Permission* Parents are responsible for keeping the center informed of any changes in the emergency information. If your child becomes ill during Alef Alef, you or your emergency contact will be called to take your child home. We will not release your child to anyone other than the parents unless we have authorization in writing in the Chabad office. If someone else will be picking up your child, please fill out the permission slip provided by the teachers. In case of an accident or any emergency requiring immediate attention, our first attempt will be to reach the parent, then follow the instructions on the emergency form. We will call the doctor and/or paramedics. Our staff will take every precaution necessary to provide and implement a SAFE environment for your children. I certify that no information concerning the health of this Student has been withheld or misrepresented. I authorize our physician to provide further medical history should it be deemed necessary. I give permission to Chabad Israeli Center to use photos of my children in any Alef Alef publicity. Parent/Guardian* Date* Payment Details* 50% due on the first day of Alef Alef, 50% due by January 8, 2018 Last Name Total charge amount First Name Card Type Please Select Visa American Express Discover Mastercard Address Card Number City Exp. Date Month 01 02 03 04 05 06 07 08 09 10 11 12 Year 2018 2019 2020 2021 2021 2022 2023 2024 2025 State CVV code 3 digits on back of card Zip Comments This page uses 128 bit SSL encryption to keep your data secure.