Cteen Level Up

Friendship, leadership, and Jewish pride - taken to the next level.

Twice a month, 7th–8th graders come together for an evening of games, food, friendship, and hands-on Jewish experiences. Whether it’s a hilarious team challenge, a deep conversation about life, or giving back through a community project - you’ll leave feeling inspired and connected.

These are the dates, cost is $1300 for the year. Can you mimic the HS registration form for this program?

Sept. 15 & 29

Oct 20

Nov 3 & 17

Dec 1 & 15

Jan. 12 & 26

Feb. 9 & 23

March 2 (Purim) & 9

Apr. 13

May 4 & 18

Parental Marital Status*

Your Name*

First Name Last Name

Your Email*

Your Phone Number*

I am the Child's*

FatherMotherLegal Guardian

Your Background*

Jewish by birthJewish by conversionNot Jewish

Home Address*

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

I authorize my telephone number and email address to be published in a class list*

YesNo

Parent A: Name*

First Name Last Name

Parent A: Phone Number*

Parent A: E-mail*

Parent A Background*

Jewish by birthJewish by conversionNot Jewish

Parent B: Name*

First Name Last Name

Parent B: Phone Number*

Parent B: E-mail*

Parent B Background*

Jewish by birthJewish by conversionNot Jewish

Primary Contact*

Parent AParent BBoth

Volunteer I am available to volunteer as a chaperone for local field trips, assist in special programming or have special interests or skills I would like to bring into the classroom

Let us know your expectations: I want my child's experience to be:

The best compliment is a referral. Please suggest a family that would appreciate an invite to future programs. Please include Name, Address, Phone # & Email if possible

Number of children being registered* $1300 for the year

Have there been any conversions or adoptions in the family?* Please include as much information as possible. If not, write "N/A"

Is Child 1 a...*

Returning StudentNew Student

Full Name*

First Name Last Name

Hebrew Name

Birth Date*

Month Day Year

at Hour Minutes

School in the Fall*

Grade entering in the Fall*

Current Grade*

Hebrew Reading Proficiency*

NoneSomewhatWell

Previous Jewish Education*

YesNo

Is your child currently receiving any services or have an Individualized Education Program (IEP)?* Write "N/A" if this does not apply

Does your child have any allergies (e.g., medications, foods, etc.)? Please provide details.* Please email us at hebrewschool@chabadoftribeca.com to schedule a meeting to discuss your child's allergy plan.

Does your child have an EpiPen?*

YesNo

Are there any medical conditions we should be aware of?*

Is Child 2 a...*

Returning StudentNew Student

Full Name*

First Name Last Name

Hebrew Name

Birth Date*

Month Day Year

at Hour Minutes

School in the Fall*

Grade entering in the Fall*

Current Grade*

Hebrew Reading Proficiency*

NoneSomewhatWell

Previous Jewish Education*

YesNo

Is your child currently receiving any services or have an Individualized Education Program (IEP)?* Write "N/A" if this does not apply

Does your child have any allergies (e.g., medications, foods, etc.)? Please provide details.* Please email us at hebrewschool@chabadoftribeca.com to schedule a meeting to discuss your child's allergy plan.

Does your child have an EpiPen?*

YesNo

Are there any medical conditions we should be aware of?*

Is Child 3 a...*

Returning StudentNew Student

Full Name*

First Name Last Name

Hebrew Name

Birth Date*

Month Day Year

at Hour Minutes

School in the Fall*

Grade entering in the Fall*

Current Grade*

Hebrew Reading Proficiency*

NoneSomewhatWell

Previous Jewish Education*

YesNo

Is your child currently receiving any services or have an Individualized Education Program (IEP)?* Write "N/A" if this does not apply

Does your child have any allergies (e.g., medications, foods, etc.)? Please provide details.* Please email us at hebrewschool@chabadoftribeca.com to schedule a meeting to discuss your child's allergy plan.

Does your child have an EpiPen?*

YesNo

Are there any medical conditions we should be aware of?*

Is Child 4 a...*

Returning StudentNew Student

Full Name*

First Name Last Name

Hebrew Name

Birth Date*

Month Day Year

at Hour Minutes

School in the Fall*

Grade entering in the Fall*

Current Grade*

Hebrew Reading Proficiency*

NoneSomewhatWell

Previous Jewish Education*

YesNo

Is your child currently receiving any services or have an Individualized Education Program (IEP)?* Write "N/A" if this does not apply

Does your child have any allergies (e.g., medications, foods, etc.)? If yes, please provide details.* Please email us at hebrewschool@chabadoftribeca.com to schedule a meeting to discuss your child's allergy plan.

Does your child have an EpiPen?* If "Yes" Please email us at summer@mylittleschoolnyc.com to book a meeting to discuss your child’s allergy plan.

YesNo

Are there any medical conditions we should be aware of?*

If you have additional children, please contact us at (212) 566-6764 or hebrewschool@chabadoftribeca.com

Who is authorized to pick up your child(ren)?* Full name, contact number, relation to child

Name / Number / Relation to child

Who should Chabad of Tribeca contact in an emergency if both parents cannot be reached?* Full name, contact number, relation to child

Name / Number / Relation to child

Total

$0.00

I would like to pay today:Full amount50% minimum: $0.00 $

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

You have the option to pay in three installments that will be charged automatically over a three-month period. The first installment will be charged upon submission. To choose, select the 33.33% or the "Other" option above.

*If you choose "Other", the remaining amount due will be split in half and charged the subsequent two months.

Payment*

Credit Card

We accept Visa, MasterCard, American Express, Discover
Credit Card Number	Security Code
Name on Card
Expiration Month	Expiration Year

Billing Address

Street Address

City

State / Province

Postal / Zip Code

Country

Chabad of Tribeca is dedicated to creating a safe and healthy environment for children and it is our hope that the use of the following releases will never be needed. Nevertheless, please review and check in the spaces provided below so that we can be in compliance with certain protocols.

By signing my name in the box below, I agree to the following terms:

GENERAL RELEASE: On behalf of myself and my child, I do hereby release and discharge and agree to hold harmless Chabad of Tribeca and its members, officers, directors, employees, affiliates, and agents (including persons serving as volunteers), individually and collectively, of and from any and all liability, action, cause of action, claim, demand, and responsibility whatsoever in law and in equity, arising out of or in consequence of my child's participation, including, specifically but without limitation, bodily injury, unless same is caused by the gross negligence or willful misconduct of Chabad of Tribeca.
FIRST AID RELEASE: I give consent for the staff of Chabad of Tribeca to administer general first aid to my child(ren) when necessary.
PHOTO/AUDIO/VIDEO CONSENT: By giving approval below, it is understood that you, as the child's legal guardian, grant permission to Chabad of Tribeca, its employees and its representatives, to use, without charge, images (photograph & video) taken of you and your child(ren) on Chabad of Tribeca’s premises or in conjunction with a Chabad of Tribeca event or for the purpose of a Chabad of Tribeca publication. These images (photograph & video) may be used in any and all Chabad of Tribeca publications, including, but not limited to, electronic materials, the website, social media outlets, audio/visual presentations, promotional literature and/or advertising. It is understood that you hereby release, discharge and agree to hold harmless Chabad of Tribeca from any liability that may occur or be produced in the taking, production, processing or publication of such images.
EMERGENCY RELEASE: In the case of emergency, I hereby authorize the doctor or hospital to which my child(ren) may be brought (and whomever they may designate as their assistants) to perform any emergency procedure or operation, to give treatment and the administration of an anesthetic to my child(ren) during his/her stay in school. Please e-sign below. NOTE: It is the firm hope that the authorization granted on this will never need to be used. For the safety of the children, however, sound medical practice calls for such authorization. In emergency situations, where the parent/guardian of the child(ren) cannot be contacted immediately, this form may be extremely important. The authorization granted by this form will be used only where absolutely necessary and only after every attempt has been made first to contact the parent/guardian. We find that doctors and hospitals refuse to give any treatment, regardless of how minor, unless they have authorization from the parents/guardians. As you know, time can be a factor in being of assistance to your child(ren) where medical attention is needed, and this would assure us that no time would be lost in giving immediate attention. This authorization will be kept on file.
EMERGENCY TRANSPORTATION RELEASE: In case of emergency, I authorize Chabad of Tribeca to call emergency services and follow instructions from medical authorities--- this may include emergency transport to the nearest Hospital Emergency Room, or other medical facility for medical treatment. I understand that my child(ren) may be transported by ambulance and that I will be responsible for costs incurred for obtaining emergency medical services.
FIELD TRIP RELEASE AND AUTHORIZATION: I hereby give permission for my child(ren) to participate in trips as part of Chabad of Tribeca.
TERMINATION AND CANCELLATION:

Registration is for the full year. No refunds or deductions will be issued for student withdrawal, absences, or dismissal for any reason.

Refunds may be considered only in exceptional cases where a family relocates their primary residence beyond a reasonable commuting distance and provides written proof of relocation, or if a child is unable to participate due to medical reasons.

All refund requests will be reviewed on a case-by-case basis and are subject to a 10% administrative fee. No refunds will be granted after the start of the program.
I have read and agreed to all of the terms and conditions in this Application Form.

Agreement*

I agree to the above terms and conditions

E-Signature of Parent or Guardian*

Date*

Month Day Year

Cteen Level Up

1. Parents Information

2. Children’s Information

Child 1

Medical Information Child 1:

Child 2

Medical Information Child 2:

Child 3

Medical Information Child 3:

Child 4

Medical Information Child 4:

3. Pick-Up Authorization

4. Emergency Contacts

5. Payment Information

6. Terms and Conditions