We are currently accepting application forms for the 2024/2025 school year. Please fill out this form to the best of your ability. If you have any questions or concerns you'd like to discuss with us, please contact us. Please note that one registration form per child is needed. We look forward to a wonderful year of learning and growth. **For returning students, click here for a more condensed form Child's Profile Full Name* First Name Last Name Hebrew Name Birth Date 1 - January2 - February3 - March4 - April5 - May6 - June7 - July8 - August9 - September10 - October11 - November12 - December Month12345678910111213141516171819202122232425262728293031 Day202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920 Year School Any Previous Jewish Education? If yes, where? Any Allergies? Please specify any information, medical or otherwise, we should be aware of. Parents' Information Father's Name First Name Last Name Father's Cell Phone Number Area Code Phone Number Father's E-mail Mother's Name First Name Last Name Mother's Cell Phone Number Area Code Phone Number Mother's E-mail Have either parent had any Jewish schooling? If yes, where? Which of the biological parents of the child were born Jewish? Select all that apply MotherFatherOther - contact me Are there any conversions in the family? YesNo Are there any adoptions in the family? YesNo Emergency Contact InformationIn case of an emergency, when parents cannot be reached, please contact: Full Name First Name Last Name Phone Number Area Code Phone Number Relationship to child Family Physician Phone Number Area Code Phone Number Medical Release FormI hereby give consent to the administration of Chabad of Sierra Vista to take whatever medical measures they deem necessary, at my expense, for my child in the event of a medical emergency. * I accept Full Name First Name Last Name Date* 1 - January2 - February3 - March4 - April5 - May6 - June7 - July8 - August9 - September10 - October11 - November12 - December Month12345678910111213141516171819202122232425262728293031 Day202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920 Year Payment InformationSynagogue membership is NOT required. Payment plan available. No child will be turned away due to lack of funds. Payment plan* If you are registering more than one child, only select the sibling discount and receive $50 off for each I plan on paying the full amount for CHS - $450Sibling Discount - $50 off!I plan on paying the full amount for the Toddler Class - $200Please contact me to discuss a payment planPlease contact me regarding a scholarship Total $0.00 I would like to pay today:Full amount$10.00 minimum$ Payment Credit Card Paypal Cash or Check Credit Card We accept Visa, MasterCard, American Express Credit Card Number Security Code Name on Card1 - January2 - February3 - March4 - April5 - May6 - June7 - July8 - August9 - September10 - October11 - November12 - December Expiration Month2024202520262027202820292030203120322033 Expiration YearPaypal has been selected. 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Enrollment is considered to be for the entire school year. Parent(s) acknowledge that Hebrew School serves children who are able to function successfully in a group setting. If, in the judgement of the school's Director, the child is not able to function in a group setting, the parent may be asked to withdraw the child. Submit Should be Empty: This page uses TLS encryption to keep your data secure.