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CHS Registration

Student Information
Please complete a separate form for each child you are registering.
Child's Name*

First Name Last Name
Male/Female*

Male Female
Birth Date*

Month Day Year
Hebrew Name
Grade Entering* Fall of 2022
School Attending
Hebrew Reading*
Previous Jewish Ed. Describe Jewish Education to date
Educational Learning Style Is there anything that you can share with us about your child that will help us provide for his/her educational needs
Family Information
Mother's Name*

First Name Last Name
Mother' s Hebrew Name

Home Address* If parents live separately, please use this field for Mother's Address. Complete Father's address below

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

Mother's Email*
I would like to receive news and updates from Chabad of Sunnyvale by email. I understand that information I provide to Chabad of Sunnyvale will be used according to its Privacy Policy and I can unsubscribe at any time.
Home Phone

Area Code Phone Number
Mother's Cell*

Area Code Phone Number
Mother's Work

Area Code Phone Number
Father's Name*
Father's E-mail*
Father's Cell

Area Code Phone Number
Father's Work

Area Code Phone Number

Address - If Different than Mother's

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

Was the Student Born Jewish?*
Were the Student's Natural Parent's Born Jewish?*
Were the Student's Maternal Grandparent Born Jewish?*
Were the Student's Paternal Grandparent Born Jewish?
If you answered 'NO' to any of these questions please explain:
Payment Information
Tuition: $700
Sibling Discount: $25 off second child
Due at Registration: $100 (non-refundable)

Payment*

Credit Card Check

Postal / Zip Code

Country

Paying at this time: Minimum payment with registration is $100. Balance is due before Sep 11. Payment arrangements available.

$100 $665 $700 $0
Total

$0.00
Should be Empty:

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