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.

If you prefer you can download a 'Printer Friendly' Form and mail, email, or fax it to [email protected].

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


Student Profile
First Name
Last Name
Hebrew Name
Gender
Date of Birth
School Attending
Grade Entering
Hebrew Reading Proficiency None Somewhat Well
Hebrew Language
Proficiency
None Somewhat Well
Previous Jewish Education Yes No
Where?
Learning Difficulties Yes No
  If yes, please describe:
 
 

Parent Information

Father's Information
First Name
Hebrew Name
Work Phone Number
Cell Phone Number
Email Address
Mother's Information  
First Name
Hebrew Name
Work Phone Number
Cell Phone Number
Email Address
Family Information  
Last Name
Address
Postal Code
Home Phone Number
Fax Number
Family History  
Is Child's Father Jewish? Yes No
Is Child's Mother Jewish? Yes No
Are there any conversions in the family? Yes No
If YES, please provide details and a copy of the documents to Yachad.
Are there any adoptions in the family? Yes No
Is anyone in your family a "Kohen" or a "Levi"? Yes No
  If yes, please explain:

Is the family a member of a Synagogue?

Yes No
  If yes, please specify:
Emergency / Medical Information
Does your child have any allergies or other medical condition we should be aware of? Yes No
If yes, please describe them and indicate special precautions or care needed.


Payment/Tuition Information
Price

First Child: $760 Per School Year
Second Child & Up: $685

Fees:  Materials & Supplies + Shipping & Handling:
$100 Per Student 

Dates & Times Sunday 10:00 AM - 12:00 PM
   
Payment Information  
Tuition Amount

Fee Amount
Payment Plan

 Post-dated payments should be dated for the end of October, November, December 2020, January 2021.

The Fee Amount is to be included in your first post-dated payment.

Payment Method:*

** Check payments are to made payable to 'Chabad Lubavitch of Alberta'

Cardholder's Name:*

Card Number:*

Card Type:*

Expiration Date:*

 

Comments:

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