Returning StudentNew StudentStudent #1 InformationFull NameFirst NameLast NameHebrew NameDate of BirthMonthDayYear GenderMaleFemaleSchoolGrade (for 2020/21)Prior Judaic knowledge or backgroundStudent #2 InformationFull NameFirst NameLast NameHebrew NameDate of BirthMonthDayYear GenderMaleFemaleSchoolGrade (for 2020/21Prior Judaic knowledge or backgroundParents InfoMother's Full NameFirst NameLast NameE-mailHome Phone NumberArea CodePhone NumberCell Phone NumberArea CodePhone NumberOccupationAddressStreet 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 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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 SaharaYemenZambiaZimbabweOtherCountryMarital StatusMarriedSeparatedDivorcedSingleWidow/erHave there been adoptions in the family?YesNoIf yes, please explainHave there been conversions in the family? (grandparents/parents/children)YesNoIf yes, please explainBest form of contactEmailTextSocial MediaMedical InformationPhysicians NamePhone NumberArea CodePhone NumberInsurance namePolicy numberAllergiesNotesEmergency InformationEmergency contact #1First NameLast NameRelationshipPhone NumberArea CodePhone NumberEmergency contact #2First NameLast NameRelationshipPhone NumberArea CodePhone NumberEnrollment Options/Tuition & FeesEarly bird - $35/registration per family is valid through 8/15/2020Tracks 1 & 2: $575 per studentTrack 3: Contact for pricing Regular registration: $65/family Sibling discount: $45 off 2nd sibling priceSecurity fee: $100/family for in person Please choose from the following 3 track optionsPlease note - all tracks are subject to change as the situation allows.Track #1 - In Person Hebrew School: Classes to take place on Sundays following CDC guidelinesTrack #2 - Hebrew School Out of the Box: Live virtual classes on WednesdaysTrack #3 - Hebrew School Pods: Family or small group setting, at home or ChabadPayment optionsPay in full5 monthly payments to be charged to my cardFor other arrangements email [email protected]Total$0.00Credit Card Check Credit CardVisaMasterCardAmerican ExpressDiscoverCredit Card TypeCredit Card NumberSecurity CodeName on Card1 - January2 - February3 - March4 - April5 - May6 - June7 - July8 - August9 - September10 - October11 - November12 - DecemberExpiration Month2020202120222023202420252026202720282029Expiration YearPlease send your check to: Chabad Jewish Center of West Boynton 9406 W Boynton Beach Blvd Boynton Beach, FL 33472Yes! I’d like to be contacted about joining Chabad’s Chai Club membership! As the parent(s) or legal guardian of the above child, I/we authorize any adult acting on behalf of Chabad Hebrew School to hospitalize or secure treatment for my/our child, I/we further agree to pay all charges for that care and/or treatment. It is understood that if time and circumstances reasonably permit, Chabad Hebrew School personnel will try, but are not required, to communicate with me/us prior to such treatment. I allow my child/ren’s photographs to be used in any print or digital publications or on social media.I agree to the terms and conditions aboveSubmitShould be Empty: This page uses TLS encryption to keep your data secure.