Printed fromJewishWayne.com

JUDA-Hebrew School of the Arts

Inspiring Jewish Pride and Identity in Jewish Children - the future of Judaism.

ב"ה

Registration Form

Child 1 Information
Child's Name*
First Name Middle Name Last Name
Child's Hebrew Name*
Birth Date*

Month Day Year
School*
Grade entering (fall 2025)*
Previous Jewish Education
Child 2 Information
Child's Name
First Name Middle Name Last Name
Child's Hebrew Name
Birth Date

Month Day Year
School
Grade entering (fall 2025)
Previous Jewish Education
Child 3 Information
Child's Name
First Name Middle Name Last Name
Child's Hebrew Name
Birth Date

Month Day Year
School
Grade entering (fall 2025)
Previous Jewish Education
Parents' Information
Father's name*
First Name Last Name
Father's email*
Father's Cellphone*

Area Code Phone Number
Mother's name*
First Name Last Name
Mother's email*
Mother's Cellphone*

Area Code Phone Number

Home Address*

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

Work Address

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

Religious History
Mothers Religion*

JewishJewish by ChoiceOther
Fathers Religion*

JewishJewish by ChoiceOther
Were there any conversions in the family?*
If yes, what is the relation to the student?
Where was the conversion done?
Who performed the conversion?
Emergency Information
Emergency contact 1*
First Name Last Name
Phone Number*

Area Code Phone Number
Emergency contact 2
First Name Last Name
Phone Number

Area Code Phone Number
Medical Information (confidential)
Up to date with vaccinations*

yesno
Date of last tetanus shot*

Month Day Year
Additional medical concerns
As the parent(s) or legal guardian of the above child, I/we authorize any adult acting on behalf of Chabad Hebrew School 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 Hebrew School 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 school activities, join in class and school trips, on and beyond school properties, allow my child to be photographed while participating in Chabad Hebrew School activities, and that these pictures may be used for marketing purposes.
I accept*

Yes
Tuition & Payment
Mini Juda (Ages 4 & 5) - $995

Juda (Ages 6 & Up) - $1275
If Multi Child is selected below, discount will be applied automatically (-$100/2 children, -$275/3 Children)
Number of Mini Juda Students*
Number of Juda Students*
Multi Child Discount

2 Children3 Children
Ealy Bird Discount Early Bird Until 6/30/26

YES
+1 Multi Child Discount
Ealry Bird
+2 Multi Child Discount
Total

$0.00
Yes, I'd like to donate the cost of processing this transaction by adding 2.9%

Payment

Credit Card Check/Will Call to Set Up Payment Plan

Postal / Zip Code

Country

In an effort to keep our Hebrew School fees the lowest in the area we are requesting that tuition be paid at the beginning of the school year.

This enables us to save on administrative, stationary, curriculum, etc. costs, and allows us to plan our budget more effectively.

You may pay your balance in one sum or submit postdated checks, dated up until April 1, 2025. A credit card can be submitted as well and we can charge it in monthly installments if needed (3 % processing fee will apply to credit card transactions). No refunds or credits will be made due to absence.

If you have difficulty with the above, please call our office to coordinate other arrangements.
Should be Empty:

This page uses TLS encryption to keep your data secure.

Updates

Lorem ipsum is simply

Lorem Ipsum is simply dummy text of the printing and typesetting industry.

Educate Your Child... Educate a Generation