Enroll - Chabad of Burbank

Registration
Sundays: 10:15am - 12:00pm (Begins September, 7th.)
Child One:
Child's Name*
First Name Last Name
Hebrew Name*
Date of Birth*

Month Day Year
Exact time of day child was born? (To determine Childs Hebrew Birthday)*
School*
Previous Jewish Education**
Grade Entering*
How did your hear about CBHS?
Child Two:
Child's Name
First Name Last Name
Hebrew Name
Date of Birth

Month Day Year
Exact time of day child was born? (To determine Childs Hebrew Birthday)
School
Previous Jewish Education*
Grade Entering
Child Three:
Child's Name
First Name Last Name
Hebrew Name
Date of Birth

Month Day Year
Exact time of day child was born? (To determine Childs Hebrew Birthday)
School
Previous Jewish Education*
Grade Entering

Address*

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

Additional notable Information
Does your child (or children) have any allergies or any other medical condition we should be aware of?
As the parent(s) or legal guardian of the above child, I/we authorize any adult acting on behalf of Chabad Burbank 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 Burbank 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 Burbank Hebrew School activities and that these pictures may be used for marketing purposes
I accept

Yes
Parent's Information
Father's Name*
First Name Last Name
Father's Cell*

Area Code Phone Number
Father's E-mail*
Mother's Name*
First Name Last Name
Mother's Cell*

Area Code Phone Number
Mother's E-mail*
Mother born Jewish?*

YesNo
Conversion performed by?
Emergency contact #1*
First Name Last Name
Phone Number*

Area Code Phone Number
Emergency contact #2
First Name Last Name
Phone Number

Area Code Phone Number
Doctor name/office
Doctor number

Area Code Phone Number
Payment
TUITION AND HOW TO SAVE!

Tuition: $700 per child (includes supplies)
(If you would like to pay tuition in nine payments please call the office to set it up)

Registration Fee: $75

Sign up before August 18th and $50 Registration fee.

Sibling one discount - 10% OFF OF REGULAR TUITION

Sibling two discount - 15% OFF OF REGULAR TUITION

Referrals: Rebate of $75 for each family that signs up.

* Synagogue membership is NOT required. Please note, that no child will be turned away due to lack of funds. Please contact the office to discuss any financial considerations.
Tuition for Child One
Tuition for Child Two
Tuition for Child Three
Total

$0.00
Please select check if you would like to pay in instalments and state that in the comments

Payment

Credit Card Paypal Check

Postal / Zip Code

Country

I would like to receive news and updates by email
Comments:
E-mail
Should be Empty:

This page uses TLS encryption to keep your data secure.

Registration

Sundays: 10:15am - 12:00pm (Begins September, 7th.)

Child One:

Child Two:

Child Three:

Parent's Information

Payment