Register - Bais Chabad Torah Center

We are currently opening our doors for Hebrew School of the Arts for the school year of 2021-2022.
Please fill out all fields of this form.
If you have any questions or concerns you'd like to discuss, feel free to contact us.
Please note that one registration form per child is needed.
We look forward to a wonderful year of learning and growth.
STUDENT INFORMATION
Full Name
First NameLast Name
Birth Date
MonthDayYear
School Attending
Grader Entering
September 2021
Optional: How would you describe your child's current Jewish knowledge and Hebrew reading skills?
PARENT INFORMATION

Home Address:

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

Phone Number
Area CodePhone Number
MOTHER
Full Name
First NameLast Name
Hebrew Name
Optional
Occupation
Cell Phone Number
Area CodePhone Number
E-mail
FATHER
Full Name
First NameLast Name
Hebrew Name
Optional
Occupation
Cell Phone Number
Area CodePhone Number
E-mail
I would like to receive news and updates by email
IMPORTANT INFORMATION
Are there any conversions in your family?*
If yes, please describe:
Is anyone not Jewish in the family?*
If yes, please specify who:
What Jewish experience are you looking for for your child?
EMERGENCY INFORMATION:
Emergency Contact 1
Phone Number
Area CodePhone Number
Emergency Contact 2
Phone Number
Area CodePhone Number
ALLERGIES AND MEDICAL CONDITIONS
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.
Medical Conditions
AUTHORIZATION
As the parent(s) or legal guardian of the above child, I/we authorize any adult acting on behalf of Bais Chabad of West Bloomfield 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, we 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 Hebrew School activities and join in class trips.
Agree to Authorization
I Agree
I allow my child to be photographed while participating in Hebrew School and that these pictures may be used for marketing purposes.
Agree to Photographs
I Agree
Initials*
Verified as an electronic signature
Full Tuition Prior to September 1: $450Full Tuition: $500Tuition Installments: $250 x 2
PAYMENT OPTIONS
Total
$0.00

Payment

Credit Card Paypal Cashapp: 2482075513

Postal / Zip Code

Country

Tuition for the coming year will be $500 with a $50 discount if the form is completed before September 1.
A $50 non-refundable registration fee is required at the time of registration, this will be included in the complete tuition. The remaining balance should be paid online before the first class.
Scholarships are available upon request.
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STUDENT INFORMATION

PARENT INFORMATION

MOTHER

FATHER

IMPORTANT INFORMATION

EMERGENCY INFORMATION:

ALLERGIES AND MEDICAL CONDITIONS

AUTHORIZATION

PAYMENT OPTIONS