Registration form - Chabad of Bay Ridge
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We are currently accepting application forms for the 2016-2017 school year. Please fill out ALL fields of this form. If you have any questions or concerns you'd like to discuss with us, please contact us.

If you would prefer to fill out this paper and mail it into our office, you can print a PDF Printer Friendly Form.

Please submit a separate form for each child.

We look forward to a wonderful year of learning and growth.

Student Profile
First Name
Last Name
Hebrew Name
Email Address
Gender
DOB
School
Grade Entering
Hebrew Reading Proficiency None Somewhat Well
Hebrew Language
Proficiency
None Somewhat Well
Previous Jewish Education Yes No
Where?
Learning Difficulties Yes No
  If yes, please describe:
Parent Information
Father's Information
First Name
Hebrew Name
Work Phone #
Cell Phone #
Email Address
Mother's Information  
First Name
Hebrew Name
Work Phone #
Cell Phone #
Email Address
Family Information  
Last Name
Address
Postal Code
Home Phone #
Fax #
Family History  
Is Child's Father Jewish? Yes No
Is Child's Mother Jewish? Yes No
Are there any conversions in the family? Yes No
If YES please copy and attach conversion documents
Are there any adoptions in the family? Yes No
Is anyone in your family a "Kohen" or a "Levi"? Yes No
  If yes, please explain:

Is the family a member of a Synagogue?

Yes No
  If yes, please specify:
Emergency / Medical Information
Emergency Information

In case of illness or injury of a child at school, every effort will be made to contact the parent or guardian. If parent can not be reached please contact:
Emergency Contact 1
Name
Phone
Cell Phone
Relationship
Emergency Contact 2
Name
Phone
Cell Phone
Relationship
   
Medical Information  
Family physician Name
  Phone

Insurance provider

Insurance ID #

Does your child have any allergies or other medical condition we should be aware of? Yes No
If yes, please describe them and indicate special precautions or care needed.
Is your child up to date with vaccinations? Yes No
Medical Release
I hereby consent to the administration of Chabad of Bay Ridge Hebrew School to take whatever medical measures they deem necessary for my child in the event of a medical emergency.

I Agree
Payment/Tuition Information
Tuition Information
Price $500 Per School Year
(Snacks & Drinks Included)

Receive a 10% discount for each additional Sibling
Dates & Times Sunday 10:00 AM - 12:00 PM
   
Payment Information  
Total Amount $500
$450 (10% off - additional Sibling)
Payment Plan Please arrange payment so that we can proccess your submission.  Payment Form
If you would like to recive an  Email confirmation please confirm your email address:
 

We look forward to a wonderful year of learning and growth!

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Payment
Updates
Registration for Hebrew School is currently ongoing. Please call 718-974-6366 or register online.
Upcoming Events
There are no events posted at this time. Please contact us for more info about our events.