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Register - HS

Register - HS

Register Online

We are currently accepting application forms for the 2016-2017 school year. Please fill out ALL fields of this form. If you have any questions or concerns you'd like to discuss with us, feel free to call our director Sara Bluming at 240-621-0770 or email sara@chabadpotomac.com.

If you would prefer to fill out this paper and mail it into our office, a fillable PDF can be found here.

Please note that one registration form per child is needed.

Please click here for RETURNING STUDENTS

 

Student Profile
 
Last Name
First Name
Hebrew Name
Age
DOB
Time of Birth - In Judaism the day begins at nightfall, so in order to determine the exact date of your Jewish birthday we need to know what time of day you were born.
School
Grade Entering
 
 
Hebrew Reading Proficiency
  None Somewhat Well
Previous Jewish Education Yes No
Where?
Does your child have any learning disabilities? Please specify
(This information will help us better cater to the needs of your child.)

 

Parent Information
 
Address
City/Zip
Phone
Father's Name
Father's Occupation
Father's Cell
Father's Email
Mother's Name
Mother's Occupation
Maternal Grandmother born Jewish?
Mother born Jewish? Converted by whom?
Mother's Cell
Mother's Email

 

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.





Registration Payment Agreement
 
THIS FORM IS FOR THE REGISTRATION FEE ONLY.
TUITION PAYMENTS CAN BE MADE
BY CLICKING
HERE .
 
Registration Fee: $100
Tuition for the year, per child: $850
Discount: 10% for each additional child.
 
Tuition payments can be made by clicking here

Method of Registration payment:

Credit Card (form below)
Check (Please mail checks to Chabad of Potomac Hebrew School, attn: Mrs. Sara Bluming, director, 11826 Seven Locks Rd, Potomac MD 20854 )

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
Family Name  
Child 1 $100 registration fee
Child 2 $100 registration fee
Child 3 $100 registration fee
Total Registration Cost:  
Registration Payment
CC Type   Card Number
Billing Address   City, State, Zip
CVV   Exp Date

Total Registration Cost:

As the parent(s) or legal guardian of the above child, I/we authorize any adult acting on behalf of Chabad 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 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 Hebrew School activities and that these pictures may be used for marketing purposes.

I Accept

Name: Initials: Date:

We look forward to a wonderful year of learning and growth!

 

 

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