HS Registration

The full school calendar will be announced soon. Tuition is $1,150 per child, including a $1,100 tuition fee plus a $50 security fee. Registration will only be confirmed once a $500 payment has been received. The remaining tuition balance must be paid in full by December 1. For more information about the program, schedule, location, and policies, please click here.
Full Name*
First Name Last Name
Hebrew Name
Birth Date*

Month Day Year
Time of Birth (to determine correct jewish birthday)*
Hour Minutes

Address*

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

School Attending*
Grade Entering Sept 2026*
Parents Info
Mother's Name*
Is this the biological child of the mother listed below? *

YesNo
If no, please explain
Mother's Cell Number*
Mother's E-mail*
Father's Name*
Father's Cell Number*
Father's E-mail*
Emergency Contact
Full Name*
First Name Last Name
Relationship to student*
Cell Number*
Medical information
Does the student have any allergy?*

yesno
If yes, please list
Does the student have any medical condition we shouldbe aware of?*

yesno
If yes, please list
Medical Release: In the event of a medical emergency, I authorize Chabad/ Chai Academy Hebrew School to obtain medical care for my child as deemed necessary. I agree to be responsible for any related costs or charges.*

I agree
Hold Harmless: On behalf of myself and my child, I agree to release, hold harmless, and indemnify Chai Academy Inc., Chabad of Roslyn, any affiliated Chabad/Lubavitch organizations, and their officers, employees, agents, and representatives from any claims, losses, damages, expenses, or costs arising from or related to my child’s participation in Hebrew School.*

I agree
Phone & Dismissal Policy: I agree that my child will hand in their phone for the duration of Hebrew School and will not bring more than one device, including non-working devices. I also agree to pick up my child from the designated dismissal area at the back of the building and notify the Hebrew School staff member on duty upon arrival. Parents who arrive early with prior notice, or who have an urgent message, may contact the office during Hebrew School hours.*

I agree
Payment Policy: A $500 payment per child is required at the time of registration to confirm enrollment. Registration will only be considered complete once this payment has been received. The remaining tuition balance may be paid in full or placed on an approved payment plan. All tuition balances must be paid in full by December 1.*

I agree
Refund Policy: Tuition must be paid in full by December 1. If a child withdraws from Hebrew School before December 31, tuition may be prorated and refunded, minus a $100 administrative fee. After December 31, the full year’s tuition is due, and no refunds or credits will be issued. No refunds or credits are given for missed days due to illness, family vacations, or other absences.*

I agree
I certify that all information provided on this registration form is accurate and complete to the best of my knowledge. I have read and agree to the policies, terms, and conditions outlined above.*

I agree