Student Information This form is for RETURNING STUDENTS ONLY. If you want to register a new student, CLICK HERE Number of Children* Full Name* First Name Last Name Hebrew Name* School* Grade Entering KindergardenPre-1AGrade 1Grade 2Grade 3Grade 4Grade 5Grade 6Grade 7Grade 8 Child 2 Full Name 2* First Name Last Name Hebrew Name* School* Grade Entering KindergardenPre-1AGrade 1Grade 2Grade 3Grade 4Grade 5Grade 6Grade 7Grade 8 Child 3 Full Name 3* First Name Last Name Hebrew Name* School* Grade Entering KindergardenPre-1AGrade 1Grade 2Grade 3Grade 4Grade 5Grade 6Grade 7Grade 8 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 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. Grade K-4: $800 $700/Year + $100 Supplies fee Grades 5-8: $900 $800/Year + $100 Supplies fee Tuition Assistance Requested Donate to the Scholarship Fund for families in need $36$100$180$360$540$1000 Payment 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 manage Total $0.00 Yes, I'd like to donate the cost of processing this transaction by adding 3% Payment Terms: If checked 'other' above 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 2023 2024 2025 2026 2027 2028 2029 2030 2031 2032 Expiration Year Billing Address Street Address Street Address Line 2 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.: 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 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. Date* Month Day Year Additional Comments Referred By Submit Should be Empty: This page uses TLS encryption to keep your data secure.