registration form.png

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
Address   Card Number
City   Exp. Date
State   CVV code 3 digits on back of card
Zip   Comments