DLCHS Registration

Signup online

PLEASE NOTE:

- ALL FIRST TIME APPLICANTS MUST FIRST BE INTERVIEWED BY DIRECTOR PRIOR TO ACCEPTANCE AT DLCHS, DANIEL LEVEY CHABAD HEBREW SCHOOL.

- FILLING IN THIS APPLICATION DOES NOT GUARANTEE ACCEPTANCE AT DLCHS, UNLESS AND UNTIL NOTIFIED BY DIRECTOR. (If you make a tuition payment and your child is not accepted, your tuition will be refunded.)

- Medical / Emergency Information and Release form must still be filled out at school

- If applying for scholarship, please contact the Director, Mrs. P. Krasnjansky, and make personalized arrangements. Please fill in the form below, in any case, as each child attending must be registered
Student Information
Full Name*
First Name Last Name
Hebrew Name*
First Name Last Name
Birth Date*

Month Day Year
Time Born (to calculate Hebrew date):*

Before SunsetAfter Sunset

Address*

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

Grade entering*
School*
Does your child read Hebrew?*

NoneSomewhatWell
Does your child speak / understand Hebrew?*

NoneSomewhatWell
Previous Jewish Education, if any* If no previous Jewish education, please write NONE.
Does your child have learning or behavioral issues at his / her regular school?*

YesSomewhatNo
If the answer to the above was yes or somewhat, please detail:
Additional notable Information Please let us know if there are any allergies, medical issues or other important information we need to be aware of..
Is Child Adopted?*

YesNo
Was the child's biological mother born to the Jewish Faith?

YesNo
Family Information
Father's Name*
First Name Last Name
Father's Hebrew Name
Father's Cell*

Area Code Phone Number
Father's E-mail*
Father's info:*

Jewish by BirthJewish by Choice (Fill in conversion info below, please.)Not Jewish
Mother's Name*
First Name Last Name
Mother's Hebrew Name
Mother's info:*

Jewish by BirthJewish by Choice (Fill in conversion info below, please.)Not Jewish
Mother's Cell*

Area Code Phone Number
Mother's E-mail*
Siblings (please list names and ages)
Best way to send Hebrew School updates:*

Cell PhoneEmailHandout
Conversion: If there have been any conversions in the family, please fill in the section below.
Who converted?

Maternal GrandmotherMother (biological, in case of adoption)Paternal GrandmotherFatherChild
Type of Conversion

OrthodoxConservativeReformOther
Date of Conversion

Month Day Year
Name & location of rabbi / Bet Din that did conversion:
Contact info for rabbi / Bet Din that did conversion: Mailing address
Contact Phone Number

Area Code Phone Number
Contact E-mail
Payment
ANNUAL FEES

TUITION - $700 Snack and supply fee: $150 Maintenance Fee* - $25 TOTAL: $875

(* To cover the cost of wear and tear and damages to school / Chabad property)

Tuition fees can be paid by check or credit card. Payments should be given to the director only and not to other staff members. Tuition fees are non-refundable. Should you decide to withdraw your child from Hebrew School, your refund will be pro-rated up to February 1. After that date, no refund will be allowed for Hebrew School tuition. There are no refunds or credits for days missed due to illness, holidays, or family vacations.
Tuition Fee*

$875 : Annual tuition + fees listed above.4 monthly payments $220 each. 1st payment due now2nd child enrollment, 5% discount: $831.25Applying for tuition scholarship, to be discussed with Director: Paying $175 fees listed above.
$75 monthly security fee (Pay now for 1 - 8 months: Each amount listed is for number of months at $75/month)

$75$150$225$300$375$450$525$600
Additional donation to help cover Hebrew School costs

$54$80$100$180$360$540$1000$1800$3600
Total

$0.00

Payment

Credit Card

We accept Visa, MasterCard, American Express, Discover
Credit Card Number	Security Code
Name on Card
Expiration Month	Expiration Year

Billing Address

Street Address

City

State / Province

Postal / Zip Code

Country

I am willing to assist in school activities, please contact me
I would like to receive news and updates by email
Should be Empty:

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Student Information

Family Information

Conversion: If there have been any conversions in the family, please fill in the section below.

Payment