Registration 2023-24 Torah Program at Ben Gamla-

Child 1*

First Name Middle Name Last Name
Gender*

MaleFemale
Birth Date*

Month Day Year
Grade entering August 2023*
Allergies or medical concerns*
Friend Request 1
Friend Request 2
Child 2

First Name Middle Name Last Name
Gender

MaleFemale
Birth Date

Month Day Year
Grade entering August 2023
Allergies or medical concerns
Friend Request 1
Friend Request 2
Child 3

First Name Middle Name Last Name
Gender

MaleFemale
Birth Date

Month Day Year
Grade entering August 2023
Allergies or medical concerns
Friend Request 1
Friend Request 2
Child 4

First Name Middle Name Last Name
Gender

MaleFemale
Birth Date

Month Day Year
Grade entering August 2023
Allergies or medical concerns
Friend Request 1
Friend Request 2
If you have additional children please contact us.
2. Parent information
Mother's info*

First Name Last Name
Work Phone*

Area Code Phone Number
Cell Phone*

Area Code Phone Number
E-mail* Primary email
Father's info*

First Name Last Name
Cell Phone*

Area Code Phone Number
Work Phone*

Area Code Phone Number
E-mail*

Address*

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

3. Emergency Information
Emergency Contact*

First Name Last Name
Phone Number*

Area Code Phone Number
Relationship*
4. Payment Information
Tuition Fees:

$150 Registration* fee per child (charged at registration)

$2500 Tuition for the year (3:15pm/ 3:40pm pick up Friday 3:15pm)

$3700 Tuition for the year M-T 5pm Friday - 4:30pm
(Fridays Nov 17,Dec 1,8,5,22 late pick up will be 4:00pm due to early Shabbat )

10 percent discount for siblings

$25 Daily tuition rate (if you enroll in middle of the year or cancel during the school year)
$15 Daily Aftercare rate

*The registration fee is non refundable
Tuition payment options*

1 Payment full balance (Charged upon enrollment)10 Monthly Payments (Charged on 7/15- 4/15)
Registration Fee*
1 TUITION PAYMENT*
Total

$0.00

Payment

Credit Card

We accept Visa, MasterCard, American Express, Discover
Credit Card Number	Security Code
Name on Card
Expiration Month	Expiration Year

Billing Address

Street Address

City

State / Province

Postal / Zip Code

Country

CANCELATION POLICY*

Parents must send an email & give 30 days notice for cancellation. The tuition rate will be adjusted to a daily rate of $25 a day.
SICK/MISSED DAYS*

No refunds will be given for any withdrawals and/or incomplete attendance regardless of the reason.
LATE PICKUP*

I agree that I will be charged the daily rate $15 for late pick up if I am late for dismissal.
LATE PICK UP*

I agree that the Chabad Hebrew School at BG will charge my card a $1 a minute late fee after 5:00pm weekdays Friday 4:30pm
PERSONAL PROPERTY*

Chabad Hebrew School is not responsible for any stolen or lost items brought to school. Please do not send your child with expensive electronics or toys
EMERGENCIES (G-D FORBID)*

If an emergency arises (G-d forbid) and none of the above numbers can be contacted, I hereby give Chabad Hebrew School permission to take whatever measure it feels proper and necessary considering circumstances.
UNRULY BEHAVIOR*

Any student who physically or emotionally harms him/herself or others is subject to suspension at the schools discretion.
PROPERTY DAMAGE *

Any school property damaged by a child, will be the responsibility of the parents to fix/ replace or reimburse.
MEDIA*

Chabad Hebrew School is hereby granted permission to use any photo or video showing our child/ren involved in school activities.
TRIPS AND EXCURSIONS*

I hereby give Chabad Hebrew School permission to take my child on all outings and trips and to sign any & all permission slips on behalf of my child.
General comments
A $150 per child registration fee will be charged when you submit this form. This fee is non refundable.
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2. Parent information

3. Emergency Information

4. Payment Information