Hebrew School Registration 2025-26 1. Parents Information Parental Marital Status* MarriedSeparatedDivorcedFather DeceasedMother DeceasedSingle Parent Your Name* First Name Last Name Your Email* Your Phone Number* I am the Child's* FatherMotherLegal Gaurdian Your Background* Jewish by birthJewish by conversionNot Jewish Home Address* Street Address Street Address Line 2 City State / Province Postal / Zip CodePlease SelectUnited StatesAfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanThe BahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChilePeople's Republic of ChinaRepublic of ChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongoCook IslandsCosta RicaCote d'IvoireCroatiaCubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonThe GambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorthern MarianaNorwayOmanPakistanPalauPanamaPapua New GuineaParaguayPeruPhilippinesPitcairn IslandsPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint BarthelemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSomalilandSouth AfricaSouth OssetiaSpainSri LankaSudanSurinameSvalbardSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTristan da CunhaTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamBritish Virgin IslandsUS Virgin IslandsWallis and FutunaWestern SaharaYemenZambiaZimbabweOther 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 Hebrew School experience to be: The best compliment is a referral. Please suggest a family that would appreciate an invite to our Hebrew school and/or Preschool and future programs. Please include Name, Address, Phone # & Email if possible 2. Children’s Information Number of children being registered* Have there been any conversions or adoptions in the family?* Please include as much information as possible. If not, write "N/A" Child 1 Is Child 1 a...* Returning StudentNew Student Full Name* First Name Last Name Hebrew Name Birth Date* Month Day Year at 123456789101112 Hour001020304050 MinutesAMPM Approximate Time of Birth for calculating Hebrew birthday* 123456789101112 Hour001020304050 MinutesAMPM 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 Program Choice Nursery & Pre-K: $1850 (TH)Kindergarten (K): $2710 (TH)Grades 1-5: $3165 (T)Grades 1-5: $3165 (TH)Grades 6 and Grade 7: $3970 (T)Grades 6 and Grade 7: $3970 (TH) Early Drop-Off?* $650 YesNo Bat and Bar 1:1 Lessons?* $150 per lesson (set of 10, $1500 total) YesNo Medical Information Child 1: Does your child have any allergies (e.g., medications, foods, etc.)? Please provide details.* Please email us at [email protected] 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?* Child 2 Is Child 2 a...* Returning StudentNew Student Full Name* First Name Last Name Hebrew Name Birth Date* Month Day Year at 123456789101112 Hour001020304050 MinutesAMPM Approximate Time of Birth for calculating Hebrew birthday* 123456789101112 Hour001020304050 MinutesAMPM 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 Program Choice w/ 10% Sibling discount Nursery & Pre-K: $1665 (TH)Kindergarten (K): $2439 (TH)Grades 1-5: $2848.5 (T)Grades 1-5: $2848.5 (TH)Grades 6 and Grade 7: $3573 (T)Grades 6 and Grade 7: $3573 (TH) Early Drop-Off?* $650 YesNo Bat and Bar 1:1 Lessons?* $150 per lesson (set of 10, $1500 total) YesNo Medical Information Child 2: Does your child have any allergies (e.g., medications, foods, etc.)? Please provide details.* Please email us at [email protected] 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?* Child 3 Is Child 3 a...* Returning StudentNew Student Full Name* First Name Last Name Hebrew Name Birth Date* Month Day Year at 123456789101112 Hour001020304050 MinutesAMPM Approximate Time of Birth for calculating Hebrew birthday* 123456789101112 Hour001020304050 MinutesAMPM 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 Program Choice w/ 10% Sibling discount Nursery & Pre-K: $1665 (TH)Kindergarten (K): $2439 (TH)Grades 1-5: $2848.5 (T)Grades 1-5: $2848.5 (TH)Grades 6 and Grade 7: $3573 (T)Grades 6 and Grade 7: $3573 (TH) Early Drop-Off?* $650 YesNo Bat and Bar 1:1 Lessons?* $150 per lesson (set of 10, $1500 total) YesNo Medical Information Child 3: Does your child have any allergies (e.g., medications, foods, etc.)? Please provide details.* Please email us at [email protected] 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?* Child 4 Is Child 4 a...* Returning StudentNew Student Full Name* First Name Last Name Hebrew Name Birth Date* Month Day Year at 123456789101112 Hour001020304050 MinutesAMPM Approximate Time of Birth for calculating Hebrew birthday* 123456789101112 Hour001020304050 MinutesAMPM 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 Program Choice w/ 10% Sibling discount Nursery & Pre-K: $1665 (TH)Kindergarten (K): $2439 (TH)Grades 1-5: $ 2848.5 (T)Grades 1-5: $2848.5 (TH)Grades 6 and Grade 7: $3573 (T)Grades 6 and Grade 7: $3573 (TH) Early Drop-Off?* $650 YesNo Bat and Bar 1:1 Lessons?* $150 per lesson (set of 10, $1500 total) YesNo Medical Information Child 4: Does your child have any allergies (e.g., medications, foods, etc.)? If yes, please provide details.* Please email us at [email protected] to schedule a meeting to discuss your child's allergy plan. Does your child have an EpiPen?* If "Yes" Please email us at [email protected] 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 [email protected] 3. Pick-Up Authorization Who is authorized to pick up your child(ren)?* Full name, contact number, relation to child Name / Number / Relation to child 4. Emergency Contacts Who should the Hebrew School team contact in an emergency if both parents cannot be reached?* Full name, contact number, relation to child Name / Number / Relation to child 5. Payment Information Scholarship Fund Please consider donating towards our scholarship fund. Choose from $360 or your own amount I would like to donate $360 towards covering a child's scholarship in Hebrew School Total $0.00 I would like to pay today:Full amount33.33% 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 Card1 - January2 - February3 - March4 - April5 - May6 - June7 - July8 - August9 - September10 - October11 - November12 - December Expiration Month2025202620272028202920302031203220332034 Expiration YearBilling Address Street Address City State / Province Postal / Zip CodePlease SelectUnited StatesAfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanThe BahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChilePeople's Republic of ChinaRepublic of ChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongoCook IslandsCosta RicaCote d'IvoireCroatiaCubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonThe GambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorthern MarianaNorwayOmanPakistanPalauPanamaPapua New GuineaParaguayPeruPhilippinesPitcairn IslandsPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint BarthelemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSomalilandSouth AfricaSouth OssetiaSpainSri LankaSudanSurinameSvalbardSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTristan da CunhaTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamBritish Virgin IslandsUS Virgin IslandsWallis and FutunaWestern SaharaYemenZambiaZimbabweOther Country 6. Terms and Conditions 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 in the Hebrew School, 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 at the Hebrew School. 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. HEBREW SCHOOL TERMINATION AND CANCELLATION: Registration is for the entire school year. No deductions or refunds are allowed for withdrawal, absence or dismissal of the student for any reason. Refunds cannot be granted unless a family relocates their primary residence out of commutable distance and demonstrates written proof of relocation, or a child is unable to participate for medical reasons. Requests will be considered on a case by case basis and subject to a 10% administrative fee. 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 Should be Empty: Submit This page uses TLS encryption to keep your data secure.
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