First Taste (3-4 year olds) - Chabad Jewish Center Of Gilbert

First Taste @ Gilbert Hebrew REGISTRATION
Child's Name*
First NameLast Name
Hebrew Name
Birth Date*
MonthDayYear
Approximate Time of Birth
This info used to determine their Hebrew Birthday
Current School or Day Care
Is Child Potty Trained?*
Parents Information

Address*

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

Father's Name*
First NameLast Name
Father Cell*
Area CodePhone Number
Father E-mail*
Employer
Position
Mother's Name*
First NameLast Name
Mother Cell*
Area CodePhone Number
Mother E-mail*
Employer
Position
Religious & Educational History (This section only for new students)
Previous Jewish Education
Does your child have any special needs, developmental delays or an IEP?*
If yes, please describe
Were there any conversions and/or adoptions in the family?*
If yes, please specify
Synagogue Affiliation
Medical Information
Up to Date with Vaccinations?*
YesNo
Is there any special medical or allergy information regarding your child?
Emergency Contact*
First NameLast Name
Phone Number*
Area CodePhone Number
Relation to Student*
City/Town*
Family Physician*
Phone Number*
Area CodePhone Number
Accident, Trip & Privacy Declaration:
Accident:As the parent or legal guardian of the above listed child, I authorize any adult acting on behalf of Gilbert 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, Gilbert Hebrew School 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 by Gilbert Hebrew School.
Privacy:I hereby give permission for my child’s photographs/videos to be used in newsletters, local newspapers, Gilbert Hebrew website or for promotion of our program. I give permission for our family contact information to be shared with other families.
Authorization*
Click to confirm consent
Parent Signature*
Payment
Hebrew School Tuition is $495 for for the 2022-2023 school year.
Tuition fees include all books, art materials and trips. Synagogue membership is not required. Affiliated and non-affiliated are welcome.
A $50 non-refundable deposit per child is due with registration. The deposit will be applied to tuition.
$25 Early Bird Discount for registration received by June 24, 2022. 10% discount for additional children in same family.
Payment Plans*
Plan A: Pay full Tuition by September 1st and receive $30 off your family's fees.Plan B: Automatically charge credit card on the first of each month, September – May
Request for Scholarship
Due to the needs and limits of our family, we would like to request a scholarship. Scholarship requests will be reviewed and responded to within 3 weeks of submission.
Scholarship Amount:
Amount we are prepared to pay towards our child’s Hebrew school tuition
Tuition Deposit*
$50
Additional Payment Toward Tuition to be paid upon submission of form.
$
Total
$0.00

Payment*

Credit Card

Credit Card Type
Credit Card Number	Security Code
Name on Card
Expiration Month	Expiration Year

Billing Address

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Country

Should be Empty:

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First Taste @ Gilbert Hebrew REGISTRATION

Parents Information

Religious & Educational History (This section only for new students)

Medical Information

Payment