Registration

We are currently accepting application forms for the 2019-2020 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 us.

At the bottom of the registration form please be sure to fill out the information needed for the $50 registration fee, which can be paid online through this secured form.

If you would prefer to fill out this paper and mail it into our office, a PDF can be found in the Parent's Handbook.

Please note that one registration form per child is needed.

We look forward to a wonderful year of learning and growth.

STUDENT INFORMATION
First Name   Last Name
Hebrew Name   D.O.B.
School   Grade Entering
Hebrew Reading Proficiency None Somewhat Well
Previous Jewish Education Yes No If yes - where?
Student is Attending
PARENT INFORMATION
Father's Name   Father's Cell
Mother's Name   Mother's Cell
Address   City, State, Zip
Home Phone   Email
Were there any conversions or adoptions in the family? Yes No
If yes, please explain:
EMERGENCY INFORMATION
Emergency Contact 1   Phone
Emergency Contact 2   Phone

CONFIDENTIAL: Does your child have any allergies or other medical condition we should be aware of? If yes, please describe them and indicate special precautions or care needed.



As the parent(s) or legal guardian of the above child, I/we authorize any adult acting on behalf of MV Hebrew School to hospitalize or secure treatment for my child, I further agree to pay all charges for that care and/or treatment. It is understood that if time and circumstances reasonably permit, MV Hebrew School personnel will try, but are not required, to communicate with me prior to such treatment. I hereby give permission for my child to participate in all school activities, join in class and school trips on and beyond school properties and allow my child to be photographed while participating in MV Hebrew School activities and that these pictures may be used for marketing purposes.

I Accept

Name:
Initials:

PAYMENT OPTIONS  


Yes, I would like to pay the registration fee of $50.00 now. I will send the remaining tuition balance at a later time. The remaining tuition balance can be paid by check, mailed to Chabad Hebrew School • 310 N Main St. • Andover, MA 01810

Yes, I would like to pay $850 (full tuition) for the coming year.

 
Billing Information      
First Name     Charge Amnt.
Last Name     Card Type
Address     Card Number
City/State/Zip   / /   Exp. Date
Phone     CVV Code 3 digits on back of card
           


We look forward to a wonderful year of learning and growth!