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Register Online

Register Online

We are currently accepting application forms for the 2017-2018 school year.

Please fill out ALL fields of this form.

If you have any questions or concerns you'd like to discuss with us feel free to call our director Rochi Galperin at 732-772-1998 or email rochi@jewishholmdel.org.

*If you prefer to download the form and send in it please click here.

Student 1 Profile
First Name
Last Name
Hebrew Name
Age
DOB


In Judaism the day begins at nightfall, so to determine the exact date of the Jewish birthday we need to know the time of day.
School
Grade Entering
Hebrew Reading Proficiency
None Somewhat Well
Previous Jewish Education
Yes No
Where?
Does your child have any learning disabilities? Please specify

This information will help us better cater to the needs of your child.
 
Student 2 Profile
First Name
Last Name
Hebrew Name
Age
DOB
Time of Birth

In Judaism the day begins at nightfall, so to determine the exact date of the Jewish birthday we need to know the time of day.
School
Grade Entering
Hebrew Reading Proficiency
None Somewhat Well
Previous Jewish Education
Yes No
Where?
Does your child have any learning disabilities? Please specify

This information will help us better cater to the needs of your child.
 
Student 3 Profile
First Name
Last Name
Hebrew Name
Age
DOB
Time of Birth

In Judaism the day begins at nightfall, so to determine the exact date of the Jewish birthday we need to know the time of day.
School
Grade Entering
Hebrew Reading Proficiency
None Somewhat Well
Previous Jewish Education
Yes No
Where?
Does your child have any learning disabilities? Please specify

This information will help us better cater to the needs of your child.
Family Information
My child is a
Are the natural father, mother and maternal grandmother of the child Jewish? Yes No
If no, please explain.
Have there been any conversions or adoptions in the family? Yes No
If yes, please explain.
Parent Information
Father's Name Cell
Email
Mother's Name
Cell
Email
Address
City
Zip
Home Phone
Synagogue Affiliation
 
To enhance our curriculum we have school events and programs.
Can you assist in event planning?
* Email allows us to communicate in the most efficient and economical manner. We do not use your address for other purposes.
Emergency Information
Emergency Contact 1
Phone
Relationship
Emergency Contact 2
Phone
Relationship
Family Physician
Phone
 
CONFIDENTIAL: Does your child have any allergies or other medical condition we should be aware of? If yes, please describe them and indicate special precautions or care needed.
Tuition Agreement
Tuition for the 2017-2018 school year is $750 per child and $100 registration fee.

Installments:
Payment Information
Payment Method   Checks can be mailed to 2 Spring Valley Drive Holmdel, NJ 07733.
Total Registration Cost   Card Number
Expiration   CVV
Additional Comments (optional):
Terms of Agreement
I agree that in the event of an emergency, Chabad Hebrew School has my permission to arrange for any necessary first-aid or care by a licensed physician/first-aid worker. Chabad Hebrew School has my permission to use my child's photo in its publicity materials. I have completed the Enrollment Form and agree to pay any balance according to the terms of agreement outlined above.
Name:
Initials:


We look forward to a wonderful year of learning and growth!

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