Little Scholars - Cong. Sha'arei Israel - Chabad Center of Raleigh

Registration:
Child's Name:*
First NameLast Name
Hebrew Name:*
Birth Date:*
MonthDayYear
Preschool/School attending:*
What are some activities that your child enjoys? Does your child have any significant fears?
Does your child have any developmental delays/special needs?
Parent Information:
Father's Name:*
Father's E-mail:*
Home Phone Number:*
Area CodePhone Number
Father's Work Phone Number:*
Area CodePhone Number
Father's Cell Phone Number:*
Area CodePhone Number
Father's Occupation:*
Mother's Name:*
Mother's E-mail:*
Mother's Work Phone Number:*
Area CodePhone Number
Mother's Cell Phone Number:*
Area CodePhone Number
Mother's Occupation:*

Address:*

Doctor's Address:*

Allergies or other medical condition?*
*
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 for publication or for social media use, while participating in Chabad Center Hebrew School activities.
Signature:*
Date:*
MonthDayYear
Little Scholars Tuition Agreement:
The following document is a tuition agreement for the Chabad Center Hebrew School Little Scholars Program. Please read it through carefully and sign it on the line below.
Tuition Fees 2020 - 2021:
$100 (6 classes throughout the school year)
*To learn more / sign up for synagogue membership click here or visit www.jewishraleigh.org/membership
Tuition Fees 2020 - 2021:*
$100 (6 classes throughout the school year)
I would like to help sponsor another child's Little Scholars tuition:
$36$72$100
Total:
$100.00

Payment:

Credit Card Check

Postal / Zip Code

Country

If the above would present any difficulties, we are willing to help. To request financial aid, please Morah Dassy at 323-632-0185 or email her at [email protected]
*
I have read and agree to the terms outlined above.
Signature:*
Date:*
MonthDayYear
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