We are currently accepting application forms for the 2022-2023 school year.

Please fill out ALL fields of this form.

If you have any questions or concerns you'd like to discuss please contact Tzippy Misholovin 248-470-6881.

Student 1 Profile
First Name
Last Name
Hebrew Name
Age
DOB


In Judaism the day begins at nightfall, so to determine the exact date of the Jewish birthday we need to know the time of day.
School
Grade Entering
Hebrew Reading Proficiency
None Somewhat Well
Previous Jewish Education
Yes No
Where?
Does your child have any learning disabilities? Please specify

This information will help us better cater to the needs of your child.
Address
City, State, Zip
Home Phone
Email
Cell Phone
 
Student 2 Profile
First Name
Last Name
Hebrew Name
Age
DOB
Time of Birth

In Judaism the day begins at nightfall, so to determine the exact date of the Jewish birthday we need to know the time of day.
School
Grade Entering
Hebrew Reading Proficiency
None Somewhat Well
Previous Jewish Education
Yes No
Where?
Does your child have any learning disabilities? Please specify

This information will help us better cater to the needs of your child.
Address
City, State, Zip 
Home Phone
Email
Cell Phone
 
Student 3 Profile
First Name
Last Name
Hebrew Name
Age
DOB
Time of Birth

In Judaism the day begins at nightfall, so to determine the exact date of the Jewish birthday we need to know the time of day.
School
Grade Entering
Hebrew Reading Proficiency
None Somewhat Well
Previous Jewish Education
Yes No
Where?
Does your child have any learning disabilities? Please specify

This information will help us better cater to the needs of your child.
Address
City, State, Zip
Home Phone
Email
Cell Phone
Family Information
My child is a
Is the natural father of the child Jewish? Yes No
If no, please explain.
Is the natural mother of the child Jewish? Yes No
If no, please explain.
Is the natural maternal grandmother of the child Jewish? Yes No
If no, please explain.
Have there been any conversions or adoptions in the family? Yes No
If yes, please explain.

 

Parent Information
Father's Name Father's Hebrew Name Cell
Email
Mother's Name
Mother's Hebrew Name
Cell
Email
Home Phone
Synagogue Affiliation
 
To enhance our curriculum we have school events and programs.  Can you assist in event planning?
* Email allows us to communicate in the most efficient and economical manner. We do not use your address for other purposes.
Emergency Information
Emergency Contact 1
Phone
Relationship
Emergency Contact 2
Phone
Relationship
Family Physician
Phone
 
CONFIDENTIAL: Does your child have any allergies or other medical condition we should be aware of? If yes, please describe them and indicate special precautions or care needed.
Tuition Agreement
Tuition for the 2022-2023 school year is $400 per child including registration and book fee.
Installments:


 
Payment Information
Payment Method    
Total Registration Cost   Card Number
Expiration   CVV
Additional Comments (optional):
Terms of Agreement

I agree that in the event of an emergency, Chaim Hebrew School has my permission to arrange for any necessary first-aid or care by a licensed physician/first-aid worker. 

Chaim Hebrew School has my permission to use my child's photo in its publicity materials. 

I give permission for my child to attend all field trips and outings part of Chaim Hebrew School.

I have completed the Enrollment Form and agree to pay any balance according to the terms of agreement outlined above.
Name:
Initials:


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