Wednesday Winners Registration Form

THIS IS TO REGISTER FOR THE 'WEDNESDAY WINNERS' HEBREW IMMERSION PROGRAM - AN ADDITION TO THE SUNDAY HEBREW SCHOOL PROGRAM
The cost of this supplemental program is $500
Please fill out the form below carefully. When you press submit, this form will be sent to our administration office.
Household Info
Parent #1 Name*
First Name Last Name
Parent #1 E-mail*
Parent #1 Mobile #*

Area Code Phone Number
Parent #2 Name
First Name Last Name
Parent #2 E-mail
Parent #2 Mobile #

Area Code Phone Number
Child(ren) Info
Number of Children You Are Registering*
Child #1 Name*
First Name Last Name
Child #1 Hebrew Name
Child #1 Birth Date

Month Day Year
Child #1 Age As of start of school year
Child #1 Allergies
Child #1 Medications
Child #1 Payment Options* In addition to the Sunday Primary tuition

Full Tuition Now ($500)50% Now ($250), 50% by Jan 1st ($250)Monthly ($50 for 10 Months)
Child #2 Name*
First Name Last Name
Child #2 Hebrew Name
Child #2 Birth Date

Month Day Year
Child #2 Age As of start of school year
Child #2 Allergies
Child #2 Medications
Child #2 Payment Options

Full Tuition Now ($500)50% Now ($250), 50% by Jan 1st ($250)Monthly ($50 for 10 Months)
Child #3 Name*
First Name Last Name
Child #3 Hebrew Name
Child #3 Birth Date

Month Day Year
Child #3 Age As of start of school year
Child #3 Allergies
Child #3 Medications
Child #3 Payment Options

Full Tuition Now ($500)50% Now ($250), 50% by Jan 1st ($250)Monthly ($50 for 10 Months)
Child #4 Name*
First Name Last Name
Child #4 Hebrew Name
Child #4 Birth Date

Month Day Year
Child #4 Age As of start of school year
Child #4 Allergies
Child #4 Medications
Child #4 Payment Options

Full Tuition Now ($500)50% Now ($250), 50% by Jan 1st ($250)Monthly ($50 for 10 Months)
Child #5 Name*
First Name Last Name
Child #5 Hebrew Name
Child #5 Birth Date

Month Day Year
Child #5 Age As of start of school year
Child #5 Allergies
Child #5 Medications
Child #5 Payment Options

Full Tuition Now ($500)50% Now ($250), 50% by Jan 1st ($250)Monthly ($50 for 10 Months)
Tuition Total: $500
Tuition Total: $1,000
Tuition Total: $1,500
Tuition Total: $2,000
Tuition Total: $2,500
Due Now

$0.00
Payment Info

Payment

Credit Card eCheck Other

Postal / Zip Code

Country

Terms & Conditions
As the parent(s) or legal guardian of the above child, I/we authorize any adult acting on behalf of Chabad Hebrew School of Bethesda 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, Chabad Hebrew School of Bethesda 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 Chabad Hebrew School activities and that these pictures may be used for marketing purposes.
Confirmation*

I have read and agree to the above-stated terms. I hereby give my child permission to participate in Chabad Hebrew School of Bethesda including activities, trips, and the receiving of any medical care in the case of emergency. The above releases from liability also apply here, as well.
Signature* Typing your full name is the equivalent of providing your signature
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Household Info

Child(ren) Info

Tuition Total: $500

Tuition Total: $1,000

Tuition Total: $1,500

Tuition Total: $2,000

Tuition Total: $2,500

Payment Info

Terms & Conditions