Registration

* Scholarships and Supplemental Scholarships are available and can be issued with proof of need. Please contact [email protected] directly regarding the Scholarship Determination Process. Thank you!
Student Information
Number of Children to be Enrolled
1. Full Name*
First Name Last Name
1. Hebrew Name
First Name Last Name
1. Birth Date*

Month Day Year
1. Time and city of birth*
1. School*
1. Previous Jewish Education
1. Grade entering*
1. Hebrew Speaking Proficiency:*

NoneWellFairPoor
1. Hebrew Reading Proficiency:*

NoneWellFairPoor
Second Child:
2. Full Name
First Name Last Name
2. Hebrew Name
First Name Last Name
2. Birth Date

Month Day Year
2. Time and city of birth
2. School
2. Previous Jewish Education
2. Grade entering
2. Hebrew Speaking Proficiency:

NoneWellFairPoor
2. Hebrew Reading Proficiency:

NoneWellFairPoor
Third Child:
3. Full Name
First Name Last Name
3. Hebrew Name
First Name Last Name
3. Birth Date

Month Day Year
3. Time and city of birth
3. School
3. Previous Jewish Education
3. Grade entering
3. Hebrew Speaking Proficiency:

NoneWellFairPoor
3. Hebrew Reading Proficiency:

NoneWellFairPoor
Fourth Child:
4. Full Name
First Name Last Name
4. Hebrew Name
First Name Last Name
4. Birth Date

Month Day Year
4. Time and city of birth
4. School
4. Previous Jewish Education
4. Grade entering
4. Hebrew Speaking Proficiency:

NoneWellFairPoor
4. Hebrew Reading Proficiency:

NoneWellFairPoor

Address*

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

Additional Notable Information Please let us know if there is any important information we need to be aware of (i.e. special needs, trouble in school, adoption/foster situation, divorce, etc.).
Medical Information for All Students:
Please list all allergies including drug allergies for each child:*
Pediatrician Contact Information:*
I acknowledge that I am working with my child's doctor to manage all necessary vaccinations to ensure the safety of my child while at Hebrew School.*

Yes
Parents Information
Father's Name*
First Name Last Name
Father's Hebrew Name
Father's Cell No.*

Area Code Phone Number
Father's Email*
Mother's Name*
First Name Last Name
Mother's Hebrew Name
Mother Jewish by:*

BirthConversion
If by Conversion, where was it completed?
Mother's Cell No.*

Area Code Phone Number
Mother's Email*
Emergency Contact Information
Emergency Contact Name*
First Name Last Name
Phone Number*

Area Code Phone Number
Relationship to Child*
Payment
Tuition*

One child/monthlyOne child/yearTwo Children/monthlyTwo Children/yearlyThree Children/monthlyThree Children/yearlyFour Children/monthlyFour Children/yearly
I would like to sponsor a day of security for Hebrew School:

Yes - $100No
I would like to donate to the Hebrew School Scholarship Fund to help those who cannot afford:

$18$50$75$100$180$500$1000$1800
Yes, I'd like to make this a monthly recurring payment.
Total

$0.00
Disclaimer: Tuition is billed yearly or monthly based on what you indicate above. The base price for yearly tuition is $900 (This includes the cost of onsite security). Each additional child is an additional 10% off the base price. Receive an additional $25 off when you make your yearly payment in full today! If you select to pay the first month of tuition now, you indicate that you are authorizing Chabad of Henderson to set up a monthly payment to be drafted the 1st of each month for 10 months for the appropriate amount. Refunds for children withdrawing from school before the end of the school year will be granted provided that the school office is given 30 days written notice. Tuition refunds will not be granted to children withdrawing from school after April 1st . Tuition billed monthly will not be refunded after it has been charged.
I Understand and Agree: to the above.*

Yes
E-mail Receipt to: