We are currently accepting application forms for Chabad of Coronado's Hebrew School. If you are registering for the first time, please fill out ALL fields of this form. If your child has been enrolled previously, only fill out the questions noted with a red asterisk (*). If you have any questions or concerns you'd like to discuss with us, please contact us.

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

Student Profile
 
Name *
Last *
Hebrew Name
DOB
School
Grade Entering
Hebrew Reading Proficiency None Somewhat Well
Previous Jewish Education Yes No
Where?



Parent Information
 
Father's Name *
Phone
Mother's Name *
Is the child's mother Jewish? *
Was the child adopted? *
Have there been any conversions in the family history? *
Phone
Address
City
State
Zip
Email Address


Emergency Information
 
Emergency Contact 1
Phone
Emergency Contact 2
Phone

Doctor
Address
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.

Payment Information *
$600 Registration & book fee

I would like to pay a one time installment of $600

Please charge my card $60 a month per child for 10 months

Credit Card Number *
Billing Address *
CVV *
Expiration Date *

Comments


As the parent(s) or legal guardian of the above child, I/we authorize any adult acting on behalf of Chabad 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, Chabad 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 Chabad Hebrew School activities and that these pictures may be used for marketing purposes.

I Accept

Name: Initials:

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