JUDA New Student Enrollment 2026/27

Father's Name*

First Name Last Name

E-mail*

Mobile*

Is the father Jewish?*

YesNoYes, Converted

Mother's Name*

First Name Last Name

E-mail*

Mobile*

Is the mother Jewish?*

YesNoYes, Converted

Child Primary Address*

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

Marital Status of Parents *

Number of children being registered:*

Child 1:*

First Name Last Name

Hebrew Name

Birth Date*

Month Day Year

Please indicate time of birth:*

Before sunsetAfter sunsetUnknown

School child is attending in the fall*

Grade child is entering in the fall *

Is child adopted?*

YesNo

List any medications child is currently:*

List any allergies to food or medications:*

Does the child need an epi pen? *

YesNo

Does your child have any medical, developmental or behavioral issues that we should know about?*

Hebrew Letters & language skills*

RecognizeReadWriteSpeak

Consent:*

1. PARENTAL CONSENT: I hereby give consent for my child to participate in all activities at Chabad Hebrew School unless I advise you otherwise in writing.2. PAYMENT AND CANCELLATION: Payment must be received at time of acceptance. For all payment arrangements, a payment schedule must be coordinated with our office and post-dated checks submitted at time of registration. Hebrew School tuition is non-refundable.3. MEDICAL CARE: In case of emergency, I hereby give permission to the physician selected by the Hebrew School Director, to hospitalize, to secure proper treatment for and to order injection, anesthesia, or other procedure deemed necessary for my child by an M.D. as named on this form or if unavailable another M.D.. Every effort will be made to contact the parent / guardian and emergency contacts first. Should it be necessary for the well being of the student to utilize outside medical or dental services all expenses involved will be paid for by the parent. To the best of my knowledge, my child is in good health and I will notify Chabad if he/she is exposed to any infectious diseases.4. IMAGES, ETC.: Permission is hereby given to use in promoting Hebrew School and in other ventures directly relating to Chabad (i) digital, photographic and video images or likenesses of student; audio of student; and (ii) statements, articles, names, music, art, photographs, audio recordings, films and videos created by student or originating from Hebrew School or related activity.5. INDEMNIFY & HOLD HARMLESS: I further release and agree to indemnify and hold harmless Boca Beach Chabad and its officers, servants or assigns from any liability concerning our child’s involvement in Hebrew School activities and further agree that the use of any premises during Hebrew School is made at the risk of the registrant.

Child 2:*

First Name Last Name

Child 2: Hebrew Name*

Child 2: Birth Date*

Month Day Year

Child 2: Please indicate time of birth:*

Before sunsetAfter sunsetUnknown

Child 2: School child is attending in the fall*

Child 2: Grade child is entering in the fall*

Child 2: Is child adopted?*

YesNo

Child 2: List any medications child is currently:*

Child 2: List any allergies to food or medications:*

Child 2: Does the child need an epi pen?*

YesNo

Child 2: Does your child have any medical, developmental or behavioral issues that we should know about?*

Child 2: Hebrew Letters & language skills*

RecognizeReadWriteSpeak

Child 3: Name*

First Name Last Name

Child 3: Hebrew Name: *

Child 3: Birth Date*

Month Day Year

Child 3: Please indicate time of birth:*

Before sunsetAfter sunsetUnknown

Child 3: School child is attending in the fall*

Child 3: Grade child is entering in the fall*

Child 3: Is child adopted?*

YesNo

Child 3: List any medications child is currently:*

Child 3: List any allergies to food or medications:*

Child 3: Does the child need an epi pen?*

YesNo

Child 3: Does your child have any medical, developmental or behavioral issues that we should know about?*

Child 3: Hebrew Letters & language skills*

RecognizeReadWriteSpeak

Emergency Contact Full Name*

First Name Last Name

Emergency Contact Cell Phone*

Please send a confirmation email to:*

Tuition & Fees

Registration fee: $150 due at sign-up (this fee is applied toward your total tuition)
Total tuition: $1,750 per child (includes registration fee and security fee)

Discounts

Early bird: Registration fee waived
Refer a new family: Receive $150 off tuition

Payment Policy

Tuition payments will be processed once registration is confirmed

Scholarships Available
No child will be turned away due to financial constraints.

Child 1 Payment Plan:

1: Full payment upon acceptance.2: Tuition collected in two payments: half upon acceptance and half 4 months following.

Child 2 Payment Plan:

1: Full payment upon acceptance.2: Tuition collected in two payments: half upon acceptance and half 4 months following.

Child 3 Payment Plan:

1: Full payment upon acceptance.2: Tuition collected in two payments: half upon acceptance and half 4 months following.

Total (tuition payment will not be processed until registration is confirmed):

$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

Please tell us how heard about us:*

Family Info

Child Information

Emergency Contact Information

Payment & Agreement Information

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