Returning Student Registration

This form is for returning students.

A separate New Student Registration Form must be filled out for any siblings joining for the first time.

New This Year! First child will be regular price. Additional siblings will receive a $50 discount
Parent Name:*
First Name Last Name
How many children are you registering as returning students? *
Student Information - Child 1
Full Name:*
First Name Last Name
Grade Entering:*
Does this student have any allergies?*

YesNo
If yes, please list them:*
Does this student have an IEP?*

YesNo
If yes, please explain:*
Child 2
Full Name:*
First Name Last Name
Grade Entering:*
Does this student have any allergies?*

YesNo
If yes, please list them:*
Does this student have an IEP?*

YesNo
If yes, please explain:*
Child 3
Full Name:*
First Name Last Name
Grade Entering:*
Does this student have any allergies?*

YesNo
If yes, please list them:*
Does this student have an IEP?*

YesNo
If yes, please explain:*
Other Information
Primary email for parent communication:
As the parent(s) or legal guardian of the above child, I/we authorize any adult acting on behalf of the Moldau 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, the Chabad 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 the Chabad Hebrew School activities and that these pictures may be used for marketing purposes.*

I accept
Name and Initials:*
Name: Initials:
Tuition
Your application is not complete without a payment plan.

Moldau Hebrew School does not reject anyone due to lack of funds. If you feel that you need a special payment plan please call our office at 407-636- 5994.

COSTS PER CHILD:
Tuition: $1150. Registration fee: $50.
Tuition fee is all inclusive of security fees, supplies, and also includes Ckids club event experiences.
Register before May 30th to get $100 dollars off each child's tuition.
Siblings discount: First child is regular price. Siblings will receive $50 discount
Please select your payment plan: (Today you will be only charged the registration fee.)

Pay in full (charged August 1)10 monthly payments (starting Aug 1, charged monthly)Two installments (charged Aug 1 and Jan 1)
Registration Fee ($50 per child):

$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

Please select:*

Use this same credit card for hebrew school paymentsUse my card on file for hebrew school payments
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Educate Your Child... Educate a Generation

Student Information - Child 1

Child 2

Child 3

Other Information

Tuition