Dear Parents,We are currently accepting application forms for the 2022-2023 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 Chayale by Phone: 646 283 5126 or by Email:[email protected]. We look forward to a wonderful year of learning and growth.The best compliment we can get is telling your friends about us! Please spread the word to any other potential new Hebrew School families!Wishing you all a healthy and happy summer!RETURNING Student Registration : If you are a returning student, please CLICK HERE.Student InformationNumber of Children*Full Name*First NameLast NameHebrew Name*Gender*MaleFemaleE-mailDate of Birth*1 - January2 - February3 - March4 - April5 - May6 - June7 - July8 - August9 - September10 - October11 - November12 - DecemberMonth12345678910111213141516171819202122232425262728293031Day2022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920YearSchool*Grade Entering*Previous Jewish EducationChild 2Full Name 2*First NameLast NameHebrew Name*Gender*MaleFemaleE-mailDate of Birth*1 - January2 - February3 - March4 - April5 - May6 - June7 - July8 - August9 - September10 - October11 - November12 - DecemberMonth12345678910111213141516171819202122232425262728293031Day2022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920YearSchool*Grade Entering*Previous Jewish EducationChild 3Full Name 3*First NameLast NameHebrew Name*Gender*MaleFemaleE-mailDate of Birth*1 - January2 - February3 - March4 - April5 - May6 - June7 - July8 - August9 - September10 - October11 - November12 - DecemberMonth12345678910111213141516171819202122232425262728293031Day2022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920YearSchool*Grade Entering*Previous Jewish EducationParents InformationFather's Name*First NameLast NameHebrew NameFathers Jewish Status*Born JewishConvertedNot JewishIf Converted, Please provide Conversion Rabbi's (or Rabbinical Court) informationCell Number*Area CodePhone NumberE-mail*Mother's Name*First NameLast NameHebrew NameCell Number*Area CodePhone NumberE-mail*Mothers Jewish Status*Born JewishConvertedNot JewishIf Converted, Please provide Conversion Rabbi's informationParents areMarriedDivorcedSingleEmergency Contact InfoPersons to be contacted in case of an emergency when parents cannot be reachedEmergency Contact*First NameLast NameEmergency Number*Area CodePhone NumberRelationship to the Child*CONFIDENTIAL: Any allergies or medical condition we should be aware of?*YesNoIf YES please describe. Please specify which Child if more than one.Confidential: Does child have any learning or physical disabilities? (SHARING THIS INFORMATION WITH US ENABLES US TO CREATE A HEBREW SCHOOL ENVIRONMENT IN WHICH YOUR CHILD CAN THRIVE)*YesNoTuition ScheduleThese terms will apply should your child be accepted.Program & Tuition Agreement I hereby confirm my child’s enrollment in Aleph Bay Hebrew School.I represent that I am the custodial parent or legal guardian of the child that I am enrolling and that the informationI have provided is true and correct. I agree to Aleph Bay Hebrew School's terms and conditions as outlined in the Parent Handbook.I fully understand that this enrollment, as part of my commitment to a long-term Jewish education at Aleph Bay, is accepted only on the basis of the full year program, and agree to pay the full annual or Monthly fees accordingly. I understand that no refunds or adjustments will be made for absences including, but not limited to, illness or vacation.I fully understand that by choosing monthly payment, Aleph Bay will charge my card automatically every month (upon acceptance).Annual Tuition*Tuition Fees cover all weekly activites, snacks, and drinksKindergarten-Grade 4: $700 Tuition + $100 Supplies & Deposit feeGrades 5-7 (Bar/Bat Mitzvah Club): $800 Tuition + $100 Supplies & Deposit FeeTuition Assistance RequestedDonate to the Scholarship Fund for families in need$36$100$180$360$540$1000Payment Plan*Pay in full9 Equal Payments charged the 1st of each month (September-May) (5% additional fee)Other: Please complete the field below with a payment proposal you can manageTotal$0.00Yes, I'd like to donate the cost of processing this transaction by adding 3%Payment Terms:If checked 'other' aboveYour card will only be charged for the deposit fee. Monthly and Annual Payments will be Charged starting September 1st.Payment*Payment will NOT be charged at this time. It will be set-up based on your preferences checked above.Credit CardVisaMasterCardAmerican ExpressDiscoverCredit Card TypeCredit Card NumberSecurity CodeName on Card1 - January2 - February3 - March4 - April5 - May6 - June7 - July8 - August9 - September10 - October11 - November12 - DecemberExpiration Month2022202320242025202620272028202920302031Expiration YearBilling AddressStreet AddressStreet Address Line 2CityState / ProvincePostal / 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 SaharaYemenZambiaZimbabweOtherCountryCCV*3 or 4 Digit Security CodeImportant - Permissions1. PARENTAL CONSENT: I hereby give consent for my child to participate in all activities at Chabad Hebrew School unless I advise you otherwise in writing.*I Accept2. PAYMENT AND CANCELLATION: Payment in full must be received at time of registration. For all other payment arrangements, a payment schedule must be coordinated with our office and post-dated checks submitted at time of registration. Hebrew School tuition is non-refundable.*I Accept3. MEDICAL CARE: In case of emergency, I hereby give permission to the physician selected by the Hebrew School Director, to hospitalize, to secure proper treatment for and to order injection, anesthesia, or other procedure deemed necessary for my child by an M.D. as named on this form or if unavailable another M.D.. Every effort will be made to contact the parent / guardian and emergency contacts first. Should it be necessary for the well being of the student to utilize outside medical or dental services all expenses involved will be paid for by the parent. To the best of my knowledge, my child is in good health and I will notify Chabad if he/she is exposed to any infectious diseases.*I Accept4. IMAGES, ETC.: Permission is hereby given to use in promoting Hebrew School and in other ventures directly relating to Chabad (i) digital, photographic and video images or likenesses of student; audio of student; and (ii) statements, articles, names, music, art, photographs, audio recordings, films and videos created by student or originating from Hebrew School or related activity.*I Accept5. INDEMNIFY & HOLD HARMLESS: I further release and agree to indemnify and hold harmless Chabad of Sheepshead Bay and its officers, servants or assigns from any liability concerning our child’s involvement in Hebrew School activities and further agree that the use of any premises during Hebrew School is made at the risk of the registrant.*I AcceptSIGNATURE*My e-signature will be legally binding as a printed signature.Date*MonthDayYear Additional CommentsReferred BySubmitShould be Empty: This page uses TLS encryption to keep your data secure.