Registration

Address*

Additional notable Information
Parents Information
Father's Name
First NameLast Name
Father Cell
Area CodePhone Number
Father's E-mail
Mother's Name
First NameLast Name
Mother Cell
Area CodePhone Number
Mother's E-mail
Maternal Grandmother born Jewish?
YesNo
Maternal born Jewish?
YesNo
Converted by whom? (if applicable)
Emergency Information
Emergency Contact 1
Phone
Emergency Contact 2
Phone
Doctor's Name
Doctor's Phone Number
Medical Insurance Company
Policy Number
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.
Payment
I would like to pay
I will pay $750I will pay in 10 installments of $750
Refer a friend and save 10% per family! (Friend must be new to CHS and will be registering their child for CHS this coming year)
Name of family:
Please consider sponsoring a Jewish child's education. Click here>>> to be a sponsor of our scholarship fund.
Total
$0.00

Payment

Credit Card Paypal Check

Postal / Zip Code

Country

This page uses TLS encryption to keep your data secure.

HEBREW SCHOOL REGISTRATION