Register - Chabad of Chula Vista

STUDENT REGISTRATION FORM
If you have any questions or concerns you would like to discuss with us, please feel free to call us at 301-532-2446 or email Mushka@ChabadChulaVista.com

Your Name

First Name Last Name

E-mail*

How many children would you like to re-register? Provided that information remains up to date

How many children would you like to register?

RETURNING STUDENT 1 INFORMATION

Full Name*

First Name Last Name Hebrew Name Age

Grade entering in September*

RETURNING STUDENT 2 INFORMATION

Full Name*

First Name Last Name Hebrew Name Age

Grade entering in September*

RETURNING STUDENT 3 INFORMATION

Full Name*

First Name Last Name Hebrew Name Age

Grade entering in September*

NEW STUDENT 1 INFORMATION

Full Name*

First Name Last Name Hebrew Name Age

Birth Date*

Month Day Year

Time of Day: To calculate Jewish Birth date

Hour Minutes

Gender*

MaleFemale

Grade entering in September*

Previous Jewish Education

Does your child have any allergies?*

NEW STUDENT 2 INFORMATION

Full Name*

First Name Last Name Hebrew Name Age

Birth Date*

Month Day Year

Time of Day: To calculate Jewish Birth date

Hour Minutes

Gender*

MaleFemale

Grade entering in September*

Does your child have any allergies?

NEW STUDENT 3 INFORMATION

Full Name*

First Name Last Name Hebrew Name Age

Birth Date*

Month Day Year

Time of Day: To calculate Jewish Birth date

Hour Minutes

Gender*

MaleFemale

Grade entering in September*

Does your child have any allergies?

ADDRESS

Address*

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

PARENTS INFORMATION

Marital Status

Father's Name*

First Name Last Name

Father's Occupation*

Father's Cell*

Area Code Phone Number

Father's E-mail*

Is the biological father of the child Jewish?*

YesNo

Mother's Name*

First Name Last Name

Mother's Occupation*

Mother's Cell*

Area Code Phone Number

Mother's E-mail*

Is the biological mother of the child Jewish?*

YesNo

Is the biological mother's mother of the child Jewish?*

YesNo

FAMILY INFORMATION

Have there been any conversions in your family?*

YesNo

If yes, who? And who was the Rabbi?

Have there been adoptions in your family?*

YesNo

If yes, please explain?

EMERGENCY INFORMATION & TERMS

Emergency Contact*

First Name Last Name Relationship

Phone Number*

Area Code Phone Number

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.

Terms of Agreement**

As the parent(s) or legal guardian(s) of the above child, I/we authorize any adult acting on behalf of Chabad of Chula Vista JUDA Program to hospitalize or secure treatment for my child, I further agree to pay all charges for that care and/or treatment. It is understood that if time and circumstances reasonably permit, Chabad of Chula Vista JUDA Program personnel will try, but are not required, to communicate with me prior to such treatment. I hereby give permission for my child to participate in all program activities, join in class and program trips on and beyond Chabad properties and allow my child to be photographed while participating in Chabad of Chula Vista JUDA Program activities and that these pictures may be used for marketing purposes.

Additional notable information

How did you hear about us?

Sessions

Which sessions would you like to sign up for?

Full ProgramFall SessionWinter SessionSpring Session

TUITION

Tuition: Supplies, snacks & book fee included. | Sundays 10am-12pm

Full Program (all 3 sessions, 11 classes): $520 per child
Fall Session (4 classes): $200 per child
Winter Session (4 classes): $200 per child
Spring Session (3 classes): $150 per child
Early-bird special: Register by September 28 and save 10%.
Sibling Discount: 10% off each additional child.

Every Jewish child deserves a quality education. Please don't hesitate to reach out to us for a scholarship or payment plan that can work for your family. No child will be turned away due to lack of funds.

If you are in a position to contribute to our scholarship fund, consider sponsoring a child's tuition in part ($100), in full ($499), or with any amount you're able to give.

ENROLLMENT

After you have successfully submitted your application it will be subject to review. We will reach out to discuss your application and confirm its approval. Once approved an payment form will be sent to complete your child's enrollment.