Registration for New Students - ChabadofWestHills.com

We are currently accepting application forms for the 2024-2025 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 call us on 520-405-2598.
Parent Information:
Father's Name:*
Father's First Last Name
Phone Number:*
Mother's Name:*
First Name Last Name
Phone Number:*

Address:*

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Fathers Email Address:*
Mother's Email Address:*
Student Information:
Student Profile #1:
Full Name:*
First Name Last Name
Hebrew Name:*
Birth Date:*

Month Day Year
Grade Entering:*
Hebrew Reading Proficiency:*

NoneSomewhatWell
Previous Jewish Education:*

YesNo
Where?*
Is the natural mother of the child Jewish?*

YesNo
Have there been any conversions or adoptions in the family? If Yes, please explain.*
Student Profile #2:
Full Name:
First Name Last Name
Hebrew Name:
Birth Date:

Month Day Year
Grade Entering:
Hebrew Reading Proficiency:

NoneSomewhatWell
Previous Jewish Education:

YesNo
Where?
Is the natural mother of the child Jewish?*

YesNo
Have there been any conversions or adoptions in the family? If Yes, please explain.*
Student Profile #3:
Full Name:
First Name Last Name
Hebrew Name:
Birth Date:

Month Day Year
Grade Entering:
Hebrew Reading Proficiency:

NoneSomewhatWell
Previous Jewish Education:

YesNo
Where?
Is the natural mother of the child Jewish?*

YesNo
Have there been any conversions or adoptions in the family? If Yes, please explain.*
Emergency Information:
Emergency Contact Name:*
First Name Last Name
Phone Number:*

Area Code Phone Number
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
Annual Tuition $800 | Registration and Book Fee $150 | Annual Security Fee $150 Please note that there are two payment options to pay in full or in monthly installments.
Option 1 Payment in Full:
Full Payment Options: (Receive a discount of $20 - per child)

1 Child: $10802 Children: $20103 Children: $2940
Option 2 Payment in Installments:
Installment Payment Options:

1 Child: $300 Now (Book, Registration and Security Fee Additional 8 Monthly Payments of $100)2 Children: $450 Now (Book & Registration Fee Additional 8 Monthly Payments of $200)3 Children: $600 Now (Book & Registration Fee Additional 8 Monthly Payments of $300)
Total:

$0.00

Payment:

Credit Card

We accept Visa, MasterCard, American Express, Discover
Credit Card Number	Security Code
Name on Card
Expiration Month	Expiration Year

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.
If for any reason you decide to cancel during the year, you will be refunded from the beginning of the next month.
There are no refunds after May 1st and your card will continue to be charged until you complete all your payments.
I Accept
Name:*
Initials:*
We look forward to a wonderful year of learning and growth!
Should be Empty:

Parent Information:

Student Information:

Emergency Information:

Payment Information

Option 1 Payment in Full:

Option 2 Payment in Installments: