We are currently accepting application forms for the 2018-2019 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.

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

Student 1 Profile   Student 2 Profile
First Name
  First Name
Last Name
  Last Name
Hebrew Name
  Hebrew Name
Age
  Age
DOB
  DOB


In Judaism the day begins at nightfall, so to determine the exact date of the Jewish birthday we need to know the time of day.		   Time of Birth

In Judaism the day begins at nightfall, so to determine the exact date of the Jewish birthday we need to know the time of day.
School
  School
Grade Entering
  Grade Entering
Hebrew Reading Proficiency
None Somewhat Well		   Hebrew Reading Proficiency
None Somewhat Well
Previous Jewish Education
Yes No		   Previous Jewish Education
Yes No
Where?
  Where?
Does your child have any learning disabilities? Please specify

This information will help us better cater to the needs of your child.		   Does your child have any learning disabilities? Please specify

This information will help us better cater to the needs of your child.

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Family Information
My child is a
Are the natural father and mother of the child Jewish? Yes No
If no, please explain.
Have there been any conversions or adoptions in the family? Yes No
If yes, please explain.
Parent Information
Father's Name Father's Cell Mother's Name
Mother's Cell
Home Phone
Address
City
Zip
Email*
Synagogue Affiliation
To enhance our curriculum we have school events and programs.
Can you assist in event planning?
Emergency Information
Emergency Contact 1
Phone
Relationship
Emergency Contact 2
Phone
Relationship
Family Physician
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.
Tuition Agreement
Tuition for the 2016-2017 school year is $600 per child (snacks and drinks included)
Installments:
Payment Information
Payment Method   Checks can be mailed to Chabad of Park City • P.O. Box 681818 • Park City, UT 84068
Card Type   Card Number
Expiration   CVV
Additional Comments (optional):
Terms of Agreement
I agree that in the event of an emergency, Chabad Hebrew School has my permission to arrange for any necessary first-aid or care by a licensed physician/first-aid worker. Chabad Hebrew School has my permission to use my child's photo in its publicity materials. I have completed the Enrollment Form and agree to pay any balance according to the terms of agreement outlined above.
Initials:
 


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