Register Online We are currently accepting application forms for the 2016-2017 school year. Please fill out ALL fields of this form. If you have any questions or concerns you'd like to discuss with us, please contact us. If you would prefer to fill out this paper and mail it into our office, you can print a PDF Printer Friendly Form. Please submit a separate form for each child. We look forward to a wonderful year of learning and growth. Student Profile First Name Last Name Hebrew Name Email Address Gender Boy Girl DOB Month Jan. Feb. Mar. Apr. May Jun. Jul. Aug. Sept. Oct. Nov. Date 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Year 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 5 6 7 8 9 10 11 12 Age School Grade Entering Grade Entering Kindergarten First Second Third Fourth Fifth Sixth Seventh Hebrew Reading Proficiency None Somewhat Well Hebrew Language Proficiency None Somewhat Well Previous Jewish Education Yes No Where? Learning Difficulties Yes No If yes, please describe: Parent Information Father's Information First Name Hebrew Name Work Phone # Cell Phone # Email Address Mother's Information First Name Hebrew Name Work Phone # Cell Phone # Email Address Family Information Last Name Address Postal Code Home Phone # Fax # Family History Is Child's Father Jewish? Yes No Is Child's Mother Jewish? Yes No Are there any conversions in the family? Yes No If YES please copy and attach conversion documents Are there any adoptions in the family? Yes No Is anyone in your family a "Kohen" or a "Levi"? Yes No If yes, please explain: Is the family a member of a Synagogue? Yes No If yes, please specify: Emergency / Medical Information Emergency Information In case of illness or injury of a child at school, every effort will be made to contact the parent or guardian. If parent can not be reached please contact: Emergency Contact 1 Name Phone Cell Phone Relationship Emergency Contact 2 Name Phone Cell Phone Relationship Medical Information Family physician Name Phone Insurance provider Insurance ID # Does your child have any allergies or other medical condition we should be aware of? Yes No If yes, please describe them and indicate special precautions or care needed. Is your child up to date with vaccinations? Yes No Medical Release I hereby consent to the administration of Chabad of Bay Ridge Hebrew School to take whatever medical measures they deem necessary for my child in the event of a medical emergency. I Agree Payment/Tuition Information Tuition Information Price $500 Per School Year (Snacks & Drinks Included) Receive a 10% discount for each additional Sibling Dates & Times Sunday 10:00 AM - 12:00 PM Payment Information Total Amount $500 $450 (10% off - additional Sibling) Payment Plan Please arrange payment so that we can proccess your submission. Payment Form If you would like to recive an Email confirmation please confirm your email address: We look forward to a wonderful year of learning and growth! This page uses 128 bit SSL encryption to keep your data secure.