Student Information

*Last Name

*First Name

Hebrew Name

*Gender

*Date of Birth

*Address

*City

*Province

*Postal Code

*Home Phone

*School

*Grade entering

Comments

Parent Information
Father

Title

First Name

Last Name

Work Phone

Cell Phone

Email

Mother

Title

First Name

Last Name

Work Phone

Cell Phone

Email

*Marital Status

*Is Mother Jewish?

If there have been adoptions or conversions in the family, please explain.

Emergency Information

Name Phone # Relation

*Emergency 1

Emergency 2

Emergency 3

Registration / Tuition & Fees

$50 Non refundable Registration & Book fee will be charged now. Tuition Fee is $675 minus Discounts and does not include the registration fee. Tuition fee can be charged either in one payment on September 1 or in three payment on the first of September, October, and November. For alternative payment plans kindly contact shaina@chabadmaple.com.

Sessions

*Payment Options


Total Amount:

A $ 25 discount will be applied to the Tuition Fees for Registrations done before June 15th. A $25 sibling discount and $25 referral discount is also available. Please note referrals in the comment section above.

Payment Information

Only registration fee ($50) will be charged at this time.

Registration Fee

Card Type

*Card Number

*Expiration Date

*Security Code

Use Information above

Name on Card

*Billing Address

*Billing Postal Code

I agree to the terms and conditions above

secure