Dear Parents, We are currently accepting application forms for the 2024-2025 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 Information Number of Children* Child's Full Name* First Name Last Name Hebrew Name* Gender* MaleFemale E-mail Date of Birth* 1 - January 2 - February 3 - March 4 - April 5 - May 6 - June 7 - July 8 - August 9 - September 10 - October 11 - November 12 - December Month 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Day 2024 2023 2022 2021 2020 2019 2018 2017 2016 2015 2014 2013 2012 2011 2010 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959 1958 1957 1956 1955 1954 1953 1952 1951 1950 1949 1948 1947 1946 1945 1944 1943 1942 1941 1940 1939 1938 1937 1936 1935 1934 1933 1932 1931 1930 1929 1928 1927 1926 1925 1924 1923 1922 1921 1920 Year School* Grade Entering 2024-25* Kindergarden Pre-1A Grade 1 Grade 2 Grade 3 Grade 4 Grade 5 Grade 6 Grade 7 Previous Jewish Education Child 2 Full Name 2* First Name Last Name Hebrew Name* Gender* MaleFemale E-mail Date of Birth* 1 - January 2 - February 3 - March 4 - April 5 - May 6 - June 7 - July 8 - August 9 - September 10 - October 11 - November 12 - December Month 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Day 2024 2023 2022 2021 2020 2019 2018 2017 2016 2015 2014 2013 2012 2011 2010 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959 1958 1957 1956 1955 1954 1953 1952 1951 1950 1949 1948 1947 1946 1945 1944 1943 1942 1941 1940 1939 1938 1937 1936 1935 1934 1933 1932 1931 1930 1929 1928 1927 1926 1925 1924 1923 1922 1921 1920 Year School* Grade Entering 2024-25* Kindergarden Pre-1A Grade 1 Grade 2 Grade 3 Grade 4 Grade 5 Grade 6 Grade 7 Previous Jewish Education Child 3 Full Name 3* First Name Last Name Hebrew Name* Gender* MaleFemale E-mail Date of Birth* 1 - January 2 - February 3 - March 4 - April 5 - May 6 - June 7 - July 8 - August 9 - September 10 - October 11 - November 12 - December Month 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Day 2024 2023 2022 2021 2020 2019 2018 2017 2016 2015 2014 2013 2012 2011 2010 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959 1958 1957 1956 1955 1954 1953 1952 1951 1950 1949 1948 1947 1946 1945 1944 1943 1942 1941 1940 1939 1938 1937 1936 1935 1934 1933 1932 1931 1930 1929 1928 1927 1926 1925 1924 1923 1922 1921 1920 Year School* Grade Entering 2024-25* Kindergarden Pre-1A Grade 1 Grade 2 Grade 3 Grade 4 Grade 5 Grade 6 Grade 7 Previous Jewish Education Parents Information Father's Name* First Name Last Name Hebrew Name Fathers Jewish Status* Born JewishConvertedNot Jewish If Converted, Please provide Conversion Rabbi's (or Rabbinical Court) information Cell Number* Area Code Phone Number E-mail* Mother's Name* First Name Last Name Hebrew Name Cell Number* Area Code Phone Number E-mail* Mothers Jewish Status* Born JewishConvertedNot Jewish If Converted, Please provide Conversion Rabbi's (or Rabbinical Court) information Parents are MarriedDivorcedSingle Emergency Contact Info Persons to be contacted in case of an emergency when parents cannot be reached Emergency Contact* First Name Last Name Emergency Number* Area Code Phone Number Relationship to the Child* CONFIDENTIAL: Any allergies or medical condition we should be aware of?* YesNo If 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)* YesNo If yes, Please explain: Tuition Schedule These 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 information I 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). Costs: Tuition Fees cover all weekly activities, snacks, drinks, and most trips. Tuition: $900 Deposit & Supplies: $150 Discounts: Please check off all those that apply. Discount will be manually deducted. Earlybird Discount: $50 off tuition (Per Child) if registered by July 1Family Discount: 10% off each additional sibling.Referral Program: I was referred by an existing Aleph Bay family [For Referral Program] Family that referred you: Payment Plan* I would like to pay now in fullI would like to pay half now and the balance by January 1, 20259 Equal Payments charged the 1st of each month (September-May) (5% additional fee)I need a more flexible payment plan. I understand that my application will not be processed until a plan is in place. Payment Terms: If a different plan is needed Tuition Assistance Requested Donate to the Scholarship Fund for families in need $36$100$180$360$540$1000 Total $0.00 Yes, I'd like to donate the cost of processing this transaction by adding 3% Your 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 Card We accept Visa, MasterCard, American Express, Discover Credit Card Number Security Code Name on Card 1 - January 2 - February 3 - March 4 - April 5 - May 6 - June 7 - July 8 - August 9 - September 10 - October 11 - November 12 - December Expiration Month 2024 2025 2026 2027 2028 2029 2030 2031 2032 2033 Expiration Year Billing Address Street Address City State / Province Postal / Zip Code Please Select United States Afghanistan Albania Algeria American Samoa Andorra Angola Anguilla Antigua and Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan The Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bosnia and Herzegovina Botswana Brazil Brunei Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Chile People's Republic of China Republic of China Christmas Island Cocos (Keeling) Islands Colombia Comoros Congo Cook Islands Costa Rica Cote d'Ivoire Croatia Cuba Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Eswatini Ethiopia Falkland Islands Faroe Islands Fiji Finland France French Polynesia Gabon The Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guernsey Guinea Guinea-Bissau Guyana Haiti Honduras Hong Kong Hungary Iceland India Indonesia Iran Iraq Ireland Israel Italy Jamaica Japan Jersey Jordan Kazakhstan Kenya Kiribati North Korea South Korea Kosovo Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macau Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia Moldova Monaco Mongolia Montenegro Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island Northern Mariana Norway Oman Pakistan Palau Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Islands Poland Portugal Puerto Rico Qatar Romania Russia Rwanda Saint Barthelemy Saint Helena Saint Kitts and Nevis Saint Lucia Saint Martin Saint Pierre and Miquelon Saint Vincent and the Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands Somalia Somaliland South Africa South Ossetia Spain Sri Lanka Sudan Suriname Svalbard Sweden Switzerland Syria Taiwan Tajikistan Tanzania Thailand Timor-Leste Togo Tokelau Tonga Trinidad and Tobago Tristan da Cunha Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu Uganda Ukraine United Arab Emirates United Kingdom Uruguay Uzbekistan Vanuatu Vatican City Venezuela Vietnam British Virgin Islands US Virgin Islands Wallis and Futuna Western Sahara Yemen Zambia Zimbabwe Other Country CCV* 3 or 4 Digit Security Code Important - Permissions 1. 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 Accept 2. 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 Accept 3. 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 Accept 4. IMAGES, ETC.: I hereby give permission for my child(ren) to be photographed in Hebrew School activities, and for the photographs to be published on the Hebrew School's website and media.* I Accept 5. 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 Accept SIGNATURE* My e-signature will be legally binding as a printed signature. 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