Hebrew School Registration

Student Information
Full Name*
First NameLast Name
Hebrew Name
First NameLast Name
Birth Date
MonthDayYear

Address*

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

Additional notable InformationPlease let us know if there are any allergies or other important information we need to be aware of.
Is your child registered at Danville Hebrew for the 2021-2022 school year?*
Yes, Please deduct $100 from tuitionNo
Parents Information
Father's Name
First NameLast Name
Father's Hebrew Name
First NameLast Name
Father's Cell
Area CodePhone Number
Mother's Name
First NameLast Name
Mother's Hebrew Name
Mother's Cell
Area CodePhone Number
Is the natural mother of the child Jewish?
YesNo
Is the natural father of the child Jewish?
YesNo
If applicable, please descibe any conversions or adoptions in your family
Accident, Privacy & Field Trip Declaration
Accident: As the parent(s) or legal guardian of [child(ren) listed], I/we authorize any adult acting on behalf of Chabad of Danville & S Ramon 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 personnel will try, but are not required to communicate with me prior to such treatment.
Trips & Outings: I hereby give permission for my child to attend and participate in all trips and outings organized as part of the program.
Privacy: I hereby give permission for my child’s photographs/videos to be used for educational or promotional purposes, which include but are not limited to, brochures, website and social media. I understand that I can withdraw my consent at any time.
Signature of parent or legal guardian:
Date Signed
MonthDayYear
Additional Comments
Addditional Comments:
Payment
Total
$695.00

Payment

Credit Card Check or Paypal

Postal / Zip Code

Country

E-mail*
I would like to receive news and updates by email
Should be Empty:

This page uses TLS encryption to keep your data secure.

Bat Mitzvah Club

BMC Registration

Student Information

Parents Information

Accident, Privacy & Field Trip Declaration

Payment

Good Times Gallery

Request More Info