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Youth Programs & Activities Hebrew School

Registration & Payments

Hebrew School Registration
1. Parents Information
Mother's Name
First Name Last Name

Address

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

Home Phone Number
Office Phone Number
Mobile Phone Number
Fax Number
E-mail
Please add to the Chabad of Mt. Olympus mailing list

YesNo
Father's Name
First Name Last Name
fathers contact information is the same as above

Address

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

Home Phone Number
Office Phone Number
Mobile Phone Number
Fax Number
E-mail
Please add to the Chabad of Mt. Olympus mailing list

YesNo
2. Child's Information
Name
Child's Hebrew Name
Birthday

Month Day Year
Age
School
Grade
Allergies or Medication
Any special medical or other information we should be aware of?
Has he/she ever received any Hebrew education?

YesNo
At
Year
Last Hebrew grade
Name of educational institute
3. Emergency Contact Information
for emergency purposes, where the parents is not available, please provide us with an emergency contact such as a relative or friend who knows the child well
Full Name
First Name Last Name
Relation to child

Address

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

Home Phone Number
Office Phone Number
Mobile Phone Number
E-mail
4. Payment Information
Amount to charge

$
Total

$0.00
Yes, I'd like to donate the cost of processing this transaction by adding 2.5%

Payment

Credit Card Check

Postal / Zip Code

Country

Please notify me when my registration complete with payment is received.
All contributions are tax-deductible.
*

I hereby register my child/ren in Chabad of Mt. Olympus Hebrew School and give permission for my child to participate in all school activities, including outings. I understand that the school does not assume responsibility for any injuries, and in case of emergency, necessary medical attention may be secured by the school.
Please note: No form will be processed unless proper payment is issued at the time of registration.
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