JUDA HEBREW SCHOOL REGISTRATION FORM
After this form is submitted you will receive an email letting you know if your child has been accepted. Questions or comments? Mrs. Rivkie Bogomilsky (973) 379-3151 or rivkie@chaicenterchabad.org
Child's Information
Child's Name
(Required)
First
Last
Hebrew Name
Address
(Required)
Street Address
City
ZIP / Postal Code
Age as of September 1, 2024:
(Required)
Date of Birth
(Required)
MM slash DD slash YYYY
Time of Birth (to calculate Hebrew Birthday)
Grade entering as of 9/24
(Required)
School Attending as of 9/24
(Required)
Gender:
(Required)
Does student have any learning challenges that we should be aware of?
Any allergies or medical condition we should be aware of?
Parents' Information
Student's Father's Name
(Required)
First
Last
Father's Hebrew Name
Father is Jewish by:
Choose One
Birth
Converted Orthodox
Converted Other
Not Jewish
Father's Cell Phone Number:
Father's Email Address:
Student's Mother's Name
(Required)
First
Last
Mother's Hebrew Name
Mother is Jewish by:
(Required)
Choose One
Birth
Converted Orthodox
Converted Other
Mother's Email Address
(Required)
Mother's Cell Phone
(Required)
Parents Are:
(Required)
Choose One
Married
Divorced
Is the family affiliated with a Synagogue, and if so which one?
Tuition
(Required)
$1,400 - one time payment
$700 - 2 payments
$475 - 3 payments, includes $25 tzedaka
Consent
(Required)
As the parent(s) or legal guardian of the above child, I/we authorize any adult acting on behalf of JUDA Hebrew School to facillitate any necessary medical treatment for my child. I hereby give permission for my child to participate in all school activities, join in class and school trips on and beyond school properties and allow my child to be photographed while participating in JUDA Hebrew School activities. I acknowledge and agree that these pictures may be used for marketing purposes.*
Total
Credit Card
(Required)
American Express
Discover
MasterCard
Visa
Supported Credit Cards: American Express, Discover, MasterCard, Visa
Card Number
Expiration Date
Month
Month
01
02
03
04
05
06
07
08
09
10
11
12
Year
Year
2025
2026
2027
2028
2029
2030
2031
2032
2033
2034
2035
2036
2037
2038
2039
2040
2041
2042
2043
2044
Security Code
Cardholder Name
Name
This field is for validation purposes and should be left unchanged.
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