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Thursday, January 17, 2019 - 11 Shevat 5779
 
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General Registration Form

General Registration Form

This form may be used to register for any of the following programs (please check one)

Hebrew School Jewish Kids Club Mommy & Me Camp Gan Yisrael Jewish Birthday Club

Child's Information

English Name
Hebrew Name
Date of Birth _/_/_
Name of School
Grade

My child (ren) is/are a (check one):

Kohen  Levi Yisroel Not Sure

 

Family Information

Father's Name
Address
City
State
Zip
Home phone:
Work
Cell
Email

Mother's Name
Address
City
State
Zip

Home phone  

Work 
Cell
Email Address

Emergency Contact

Name
Relationship
Home phone
Work
Cell

Allergy Information

Please provide any allergy or other medical information we should know about:

In the event of an emergency, Chabad of Central Florida has my permission to arrange for any necessary first aide or care by a licensed physician for my child while he/she is attending the program.

Signature of parent or legal guardian.

PAYMENT DUES*

  Members of YI Neshei** Non-Members Sponsor
Hebrew School (tuition for year) $600 $750 $1000
Hebrew School (book fee) $50 $75 $100
Jewish Birthday Club FREE $5 $100
Mommy and Me

$5 per class, $18/month,  $100/ year

$7 per class, $25/month, $175/year

$200
Camp Gan Yisrael (per week) $150 $200 $500
       

* If there are any payment concerns and to make alternative payment arrangements, please click here.

** To find out more about becoming a member of YI Neshei ($36), please click here.

*Type the code you see in the picture below.(Letters are not case-sensitive)
     
 

 


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©Copyright Merkos Chabad Lubavitch of Central Florida
2001 W. Swann Ave. Tampa, FL 33606 - Rabbi Lazer Rivkin, Regional Director - 813-966-8770
Email: info@chabadofcentralflorida.com

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