Parent Name* First Name Last Name Child's Full Name* First Name Last Name Grade entering in September 2024* Updated Info* NoneParents Cell PhoneParents EmailEmergency ContactMedication / AllergiesAddress Updated Info Registration fee* $50 - By 6/1/2024$200 - 6/2/2024 Tuition Prices:* Please select:Pre-K & Kindergarten: $600Grades 1-2: $1175Grades 3-5 & 6: $1450Grade 7-8 (Mitzvah Corps): $1450 Payment Plan* Pay in FullPayments divided over four months starting June '24Other: Please submit a proposed payment schedule Other payment plan or request tuition assistance Please suggest payment terms Manadatory Security Fund* $100 Minimum Required $100$250$500$1000$1800 Donate to the Scholarship Fund for families in need $36$100$360$500$1000$1500 Total $0.00 Yes, I'd like to donate the cost of processing this transaction by adding 3% 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* Payment will NOT be charged at this time. It will be set-up based on your preferences checked above. 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