Parents Information If any question is not applicable, please write N/A Father's Name* First Name Last Name Father's Cell* Area Code Phone Number Father's Email* Father's Occupation* Father's Hebrew Name Mother's Name* First Name Last Name Mother's Cell* Area Code Phone Number Mother's Email* Mother's Occupation* Mother's Hebrew Name Do Parents Live Together?* YesNo Address* Street Address Street Address Line 2 City State / Province Postal / Zip CodePlease SelectUnited StatesAfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanThe BahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChilePeople's Republic of ChinaRepublic of ChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongoCook IslandsCosta RicaCote d'IvoireCroatiaCubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonThe GambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorthern MarianaNorwayOmanPakistanPalauPanamaPapua New GuineaParaguayPeruPhilippinesPitcairn IslandsPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint BarthelemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSomalilandSouth AfricaSouth OssetiaSpainSri LankaSudanSurinameSvalbardSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTristan da CunhaTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamBritish Virgin IslandsUS Virgin IslandsWallis and FutunaWestern SaharaYemenZambiaZimbabweOther Country Father's Address* Street Address Street Address Line 2 City State / Province Postal / Zip CodePlease SelectUnited StatesAfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanThe BahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChilePeople's Republic of ChinaRepublic of ChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongoCook IslandsCosta RicaCote d'IvoireCroatiaCubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonThe GambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorthern MarianaNorwayOmanPakistanPalauPanamaPapua New GuineaParaguayPeruPhilippinesPitcairn IslandsPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint BarthelemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSomalilandSouth AfricaSouth OssetiaSpainSri LankaSudanSurinameSvalbardSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTristan da CunhaTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamBritish Virgin IslandsUS Virgin IslandsWallis and FutunaWestern SaharaYemenZambiaZimbabweOther Country Mother's Address* Street Address Street Address Line 2 City State / Province Postal / Zip CodePlease SelectUnited StatesAfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanThe BahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChilePeople's Republic of ChinaRepublic of ChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongoCook IslandsCosta RicaCote d'IvoireCroatiaCubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonThe GambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorthern MarianaNorwayOmanPakistanPalauPanamaPapua New GuineaParaguayPeruPhilippinesPitcairn IslandsPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint BarthelemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSomalilandSouth AfricaSouth OssetiaSpainSri LankaSudanSurinameSvalbardSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTristan da CunhaTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamBritish Virgin IslandsUS Virgin IslandsWallis and FutunaWestern SaharaYemenZambiaZimbabweOther Country Are there any conversions or adoptions in the family? Mother* YesNo Maternal Grandmother* YesNo Maternal Grandfather* YesNo Father* YesNo Paternal Grandmother* YesNo Paternal Grandfather* YesNo Please provide further details about conversions and/or adoptions in the family. Are the biological parents of the child/ren Jewish? Father* YesNo Mother* YesNo Emergency Contact Name* First Name Last Name Cell Phone* Area Code Phone Number Relationship* Student Information How many children are you enrolling?* 1 Student2 Students3 Students4 Students Child 1: Full Name* First Name Last Name Hebrew Name Birth Date* Month Day Year Time of Birth 123456789101112 Hour001020304050 MinutesAMPM Age as of 8/30/2026* Grade as of 8/302026* Pre-KKindergarten1st Grade2nd Grade3rd Grade4th Grade5th Grade6th Grade7th Grade Previous Jewish Education* Please select the program this child will be joining* Hebrew School ProgramThe Kulanu Circle - Inclusion Program To assist us in providing the best possible experience for your child, please email their IEP to [email protected]. IEP* I confirm I have emailed my child's IEP to [email protected] We want to provide the best possible experience for your child. Please describe your child's diagnosis:* Please list any allergies, food sensitivities, or applicable medical concerns:* What does your child enjoy doing the most?* What makes your child upset? What are his/her triggers?* Please provide as much information as possible regarding aggressive behaviors so our BCBA's can target decreasing these behaviors.* What strategies do you use to calm your child down?* What type of consequence/reward system do you use with your child?* Please describe your child's academic level/ability.* Can your child read?* Can your child write?* Describe your child's classroom setting. * How does your child learn best?* Is your child toilet trained?* YesNo Does your child receive ABA therapy?* YesNo Does your child have any medical conditions, allergies, special needs, or behavioral issues?* Or is there anything else we should know to help us best accommodate your child? YesNo Additional notable Information* Please let us know about any medical conditions, allergies, special needs, behavioral issues, or anything else that will help us accommodate your child Child 2: Full Name* First Name Last Name Hebrew Name Birth Date* Month Day Year Age as of 8/30/2026* Grade as of 8/30/2026* Pre-KKindergarten1st Grade2nd Grade3rd Grade4th Grade5th Grade6th Grade7th Grade Previous Jewish Education* Please select the program this child will be joining* Hebrew School ProgramThe Kulanu Circle - Inclusion Program To assist us in providing the best possible experience for your child, please email their IEP to [email protected]. IEP* I confirm I have emailed my child's IEP to [email protected]. We want to provide the best possible experience for your child. Please describe your child's diagnosis:* Please list any allergies, food sensitivities, or applicable medical concerns:* What does your child enjoy doing the most?* What makes your child upset? What are his/her triggers?* Please provide as much information as possible regarding aggressive behaviors so our BCBA's can target decreasing these behaviors.* What strategies do you use to calm your child down?* What type of consequence/reward system do you use with your child?* Please describe your child's academic level/ability.* Can your child read?* Can your child write?* Describe your child's classroom setting. * How does your child learn best? * Is your child toilet trained?* YesNo Does your child receive ABA therapy?* YesNo Does your child have any medical conditions, allergies, special needs, or behavioral issues?* Or is there anything else we should know to help us best accommodate your child? YesNo Additional notable Information* Please let us know about any medical conditions, allergies, special needs, behavioral issues, or anything else that will help us accommodate your child Child 3: Full Name* First Name Last Name Hebrew Name Birth Date* Month Day Year Grade as of 8/30/26* Pre-KKindergarten1st Grade2nd Grade3rd Grade4th Grade5th Grade6th Grade7th Grade Previous Jewish Education* Please select the program this child will be joining* Hebrew School ProgramThe Kulanu Circle - Inclusion Program To assist us in providing the best possible experience for your child, please email their IEP to [email protected]. IEP* I confirm I have emailed my child's IEP to [email protected]. We want to provide the best possible experience for your child. Please describe your child's diagnosis:* Please list any allergies, food sensitivities, or applicable medical concerns:* What does your child enjoy doing the most?* What makes your child upset? What are his/her triggers?* What strategies do you use to calm your child down?* Please provide as much information as possible regarding aggressive behaviors so our BCBA's can target decreasing these behaviors.* What type of consequence/reward system do you use with your child?* Please describe your child's academic level/ability.* Can your child read?* Can your child write?* Describe your child's classroom setting. * How does your child learn best? * Is your child toilet trained?* YesNo Does your child receive ABA therapy?* YesNo Does your child have any medical conditions, allergies, special needs, or behavioral issues?* Or is there anything else we should know to help us best accommodate your child? YesNo Additional notable Information* Please let us know about any medical conditions, allergies, special needs, behavioral issues, or anything else that will help us accommodate your child Child 4 Full Name First Name Last Name Hebrew Name Birth Date 1 - January2 - February3 - March4 - April5 - May6 - June7 - July8 - August9 - September10 - October11 - November12 - December Month12345678910111213141516171819202122232425262728293031 Day20262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920 Year Grade as of 8/30/2026 Pre-KKindergarten1st Grade2nd Grade3rd Grade4th Grade5th Grade6th Grade7th Grade Age as of 8/30/26 Previous Jewish Education Please select the program this child will be joinging Hebrew School programThe Kulanu Circle - Inclusion Program Does your child have any medical conditions, allergies, special needs, or behavioral issues?* Or is there anything else we should know to help us best accommodate your child? YesNo Additional notable Information* Please let us know about any medical conditions, allergies, special needs, behavioral issues, or anything else that will help us accommodate your child Waiver* By checking here, I hereby permit my child/ren to participate in all Hebrew School activities and trips, on and beyond the hebrew school campus.By checking here, I hereby authorize the Hebrew School, its staff and/or representatives to have my child given proper medical attention in the case of an emergency.By checking here, I authorize Chabad Hebrew School to use photographs of my child/ren during activities and trips in Hebrew School newsletters and promotional material. If your family is new to the Hebrew School and you were referred by another Hebrew School family, please write their name: Payment Due Now: Registration fee: $100 per child Total Due Now $130.00 Due later: Tuition and Security Fee We will calculate your tuition balance based on the fees and discounts listed here. We offer three payment plans: 1. Pay balance in one installment on August 1st, 2026. 2. Pay balance in two installments on August 1st, 2026 & January 1st 2027. 3. Pay balance in 10 monthly installments starting on August 1st, 2026 & finishing on May 1st 2027. Payment Plan* 1 Installment2 Installments10 Monthly Installments Authorization* I authorize Chabad Hebrew School to automatically charge my card on file based on my selected payment plan Credit Card Number Security Code Name On Card Expiration Date Zip Code I would like to receive news and updates by email Submit Should be Empty: This page uses TLS encryption to keep your data secure.
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