New Students Registration Form - Chabad of Valley Stream, North Woodmere, East Rockaway and Lynbrook

( for returning students registration form, click HERE )

Step 1: Complete the form below, or click HERE to download a printable registration form.

Step 2: Contact Itty at: (516)825-5566 or Email: chabad11581@gmail.com
to set up a new student interview.

Sundays, Pre K -8th Grade: $725

If you have any questions, feel free to contact our Hebrew School principal,
Mrs. Itty Goldshmid, who will be happy to assist you.

_________________________________________________________________________________

STUDENT 1 INFORMATION
Family Name		Is the biological mother of the child Jewish by birth? Were there any conversions or adoptions in the child's immediate or extended family? Yes No - If yes, please explain Acceptance to Hebrew School is not an endorsement of the childs Halachic status as a Jew. If necessary, the childs status will need to be verified prior to any Bar/Bat Mitzvah being performed at Chabad of Valley Stream. Has your child had any previous Hebrew Education? Yes No --- If yes, where? Does Your child read basic Hebrew? Yes No Does your child have a learning disability? Yes No If yes, please explain
First Name
Hebrew Name
Date of Birth	/ / MM / DD / YYYY format
	Age Gender Grade Entering in 2018-19
School Attending 2018/2019
Home Address
City, State, Zip

STUDENT 2 INFORMATION
Family Name		Is the biological mother of the child Jewish by birth? Were there any conversions or adoptions in the child's immediate or extended family? Yes No - If yes, please explain Acceptance to Hebrew School is not an endorsement of the childs Halachic status as a Jew. If necessary, the childs status will need to be verified prior to any Bar/Bat Mitzvah being performed at Chabad of Valley Stream. Has your child had any previous Hebrew Education? Yes No --- If yes, where? Does Your child read basic Hebrew? Yes No Does your child have a learning disability? Yes No If yes, please explain
First Name
Hebrew Name
Date of Birth	/ / MM / DD / YYYY format
	Age Gender Grade Entering in 2018-19
School Attending 2018/2019
Home Address
City, State, Zip

STUDENT 3 INFORMATION
Family Name		Is the biological mother of the child Jewish by birth ? Were there any conversions or adoptions in the child's immediate or extended family? Yes No - If yes, please explain Acceptance to Hebrew School is not an endorsement of the childs Halachic status as a Jew. If necessary, the childs status will need to be verified prior to any Bar/Bat Mitzvah being performed at Chabad of Valley Stream. Has your child had any previous Hebrew Education? Yes No --- If yes, where? Does Your child read basic Hebrew? Yes No Does your child have a learning disability? Yes No If yes, please explain
First Name
Hebrew Name
Date of Birth	/ / MM / DD / YYYY format
	Age Gender Grade Entering in 2018-19
School Attending 2018/20198
Home Address
City, State, Zip

MEDICAL INFORMATION
Persons to be contacted in case of an emergency when parents cannot be reached (Please provide 2 contacts)
Name	Phone	Relationship to Child
Name	Phone	Relationship to Child
In an emergency, when you cannot reach either parent, I authorize the school to call: Family Physician 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. As the parent(s) or legal guardian of the above child, I/we authorize any adult acting on behalf of Chabad of Valley Stream 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 of Valley Stream 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 of Valley Stream Hebrew School activities and that these pictures may be used for marketing purposes. I Accept Name: Initials:

TUITION AGREEMENT
The following document is a tuition agreement for the Chabad Hebrew School. The agreement explains the tuition fees, payments plans and refund policies. Please read it through carefully and sign it on the signature line below. The signed tuition agreement along with full payment must be submitted to the school office before any child will be permitted to attend classes. 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 January 1st. A limited number of scholarships are available upon request; no child will be turned away for lack of funds.
Tuition: $725
PLEASE CHOOSE ONE OF THE FOLLOWING TUITION OPTIONS: (can be paid by Credit card, check or cash) One full tuition payment Two payments, September 1st & January 1st I would like to arrange alternate plan

PAYMENT INFO ( optional )
Please charge my:	Visa M/C Am Ex
Card #:
Exp. Date:
Security Code:
Name on Card:
How/ From who did you hear about our Hebrew School: E-mail: