Re-Registration - Chabad Jewish Center of NWBC

Child's Full Name*

First NameLast Name

Hebrew Name*

Grade entering in September 2020*

Has any information changed for your family?
If yes , please check the box and submit new information in the field below it.
If not , please skip the next two fields.

Please Check

Parents Cell PhoneParents EmailEmergency ContactMedication / Allergies

New or changed information

Tuition Prices:*

Registration fee*

$125 - **EXPIRED** Registration fee WAIVED if paid in full by 6/4/2020$125 - After 6/4/2020

Tuition Assistance Requested

Manadatory Security Fund*$50 Minimum Required

Donate to the Scholarship Fund for families in need

Total

$0.00

Yes, I'd like to donate the cost of processing this transaction by adding 3%

Payment Plan*

Pay in FullPayment Plan Requested: Payments will be divided over four monthsOther: Please complete the field below with a payment proposal you can manage

Payment TermsIf you checked 'other' above

Consent:*

1. PARENTAL CONSENT: I hereby give consent for my child to participate in all activities at Chabad Hebrew School unless I advise you otherwise in writing.2. PAYMENT AND CANCELLATION: Payment in full must be received at time of registration. For all other payment arrangements, a payment schedule must be coordinated with our office and post-dated checks submitted at time of registration. Hebrew School tuition is non-refundable.3. MEDICAL CARE: In case of emergency, I hereby give permission to the physician selected by the Hebrew School Director, to hospitalize, to secure proper treatment for and to order injection, anesthesia, or other procedure deemed necessary for my child by an M.D. as named on this form or if unavailable another M.D.. Every effort will be made to contact the parent / guardian and emergency contacts first. Should it be necessary for the well being of the student to utilize outside medical or dental services all expenses involved will be paid for by the parent. To the best of my knowledge, my child is in good health and I will notify Chabad if he/she is exposed to any infectious diseases.4. IMAGES, ETC.: Permission is hereby given to use in promoting Hebrew School and in other ventures directly relating to Chabad (i) digital, photographic and video images or likenesses of student; audio of student; and (ii) statements, articles, names, music, art, photographs, audio recordings, films and videos created by student or originating from Hebrew School or related activity.5. INDEMNIFY & HOLD HARMLESS: I further release and agree to indemnify and hold harmless Chabad of NW Bergen County and its officers, servants or assigns from any liability concerning our child’s involvement in Hebrew School activities and further agree that the use of any premises during Hebrew School is made at the risk of the registrant.

Payment*

Credit Card

Credit Card Type
Credit Card Number	Security Code
Name on Card
Expiration Month	Expiration Year

Billing Address

Street Address

Street Address Line 2

City

State / Province

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