UPON SUBMITTING THIS FORM WITH DEPOSIT / TUITION, YOU WILL RECEIVE A LINK TO COMPLETE SCHOOL REGISTRATION INFO PARENT NAME: EMAIL ADDRESS: PHONE: ADDRESS, CITY, ZIP: I/ WE WOULD LIKE TO ENROLL MY CHILD/REN CHABAD HEBREW SCHOOL STUDENT NAME #1 GRADE AND DATE OF BIRTH STUDENT NAME #2 GRADE AND DATE OF BIRTH STUDENT NAME #3 GRADE AND DATE OF BIRTH STUDENT NAME #4 GRADE AND DATE OF BIRTH TUITION: $285.00 PER SEMESTER - (FALL SEMESTER SEP-NOV) FALL SEMESTER TUITION: $285.00 $285.00 X PLEASE CHARGE MY CREDIT CARD BELOW $285.00 PLEASE CHARGE THIS CARD ON 12/1/22 FOR THE WINTER SEMESTER AND ON 3/1/23 FOR THE SPRING No one will be turned away for lack of funds. If you are unable to pay the full amount, please write what you can pay. All tuition remains confidential. CARD NUMBER SECURITY CODE EXP MONTH EXP YEAR This page uses 128 bit SSL encryption to keep your data secure.