Registration 2026/2027 - Chabad of Bradenton

Please fill out this form and submit it together with your tuition, registration and book fees.
Parent Information:
Father's Full Name*
First Name Last Name
*

Click here if your information is the same as last year.
Father's Name:
Father's Hebrew Name:*
Work Phone Number:*

Area Code Phone Number
Other Phone Number:

Area Code Phone Number
Occupation:*
Company Name:*

Work Address:*

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

Mother's Name: *
Mother's Hebrew Name:*
Work Phone Number:*

Area Code Phone Number
Other Phone Number:

Area Code Phone Number
Occupation:*
Company Name:*

Work Address:*

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

General Information:
First Child
Child's Full Name*
First Name Last Name
Child's Hebrew Name: *
Child's Preferred Name:*
Birth Date:*

Month Day Year
Hebrew Birth Date:*
What grade is your child entering in September 2026?*
Child's E-mail:
Parent E-mail:
Home Phone Number:

Area Code Phone Number

Address*

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

Religious & Educational History:
Does your child read basic Hebrew?*

NoneSomewhatWell
Does your child have any difficulty with his general studies?
Is the child's mother Jewish? *

Yes (if adopted/converted, please specify below)No
Is the child's father Jewish?*

Yes (if adopted/converted, please specify below)No
Are there any adoptions in your family (children, parents or grandparents)?
Have you or your spouse, parents, grandparents or children ever converted to Judaism?
T-Shirt Size Selection:*

Youth - XSYouth - SYouth - MYouth - LYouth - XLAdult - SAdult - M
Would you like to register another child?

YesNo
Second Child
Second Child's Full Name
First Name Last Name
Second Child's Hebrew Name:
Second Child's Preferred Name:
Second Child Birth Date:

Month Day Year
Second Child Hebrew Birth Date:
What grade is your child entering in September 2026?
Second Child's E-mail
Religious & Educational History:
Does your child read basic Hebrew?

NoneSomewhatWell
Does your child have any difficulty with his general studies?
T-Shirt Size Selection:

Youth - XSYouth - SYouth - MYouth - LYouth - XLAdult - SAdult - M
Would you like to add another child to this registration?

yesno
Third Child
Third Child's Full Name
First Name Last Name
Third Child's Hebrew Name:
Third Child's Preferred Name:
Third Child's Birth Date:

Month Day Year
Third Child Hebrew Birth Date:
What grade is your child entering in September 2026?
Third Child's E-mail
Religious & Educational History:
Does your child read basic Hebrew?

NoneSomewhatWell
Does your child have any difficulty with his general studies?
T-Shirt Size Selection:

Youth - XSYouth - SYouth - MYouth - LYouth - XLAdult - SAdult - M
Would you like to add a New Child?

yesno
New Child
New Child's Full Name
First Name Last Name
New Child's Hebrew Name:
New Child's Preferred Name:
New Child's Birth Date:

Month Day Year
New Child Hebrew Birth Date:
What grade is your child entering in September 2026?
New Child's E-mail
Religious & Educational History:
Does your child read basic Hebrew?

NoneSomewhatWell
Does your child have any difficulty with his general studies?
T-Shirt Size Selection:

Youth - XSYouth - SYouth - MYouth - LYouth - XLAdult - SAdult - M
Emergency Contact Person:(other than parent/guardian)
Full Name
First Name Last Name
Relationship to child:
Daytime Phone Number:

Area Code Phone Number

Address

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

Authorized Persons To Pick Up Your Child: (other than parents/guardians)
Full Name #1:
First Name Last Name
Daytime Phone Number:

Area Code Phone Number
Evening Phone Number:

Area Code Phone Number

Address

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

Full Name #2:
First Name Last Name
Daytime Phone Number:

Area Code Phone Number
Evening Phone Number:

Area Code Phone Number

Address

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

Books / Judaic Supplies
Sing-a- long Siddur (ages 4-6) $30
My First Siddur (ages 7-13) - $35
Tzitzit $20
CHS Kippah $20
Method of Payment:
I am registering my child for:

Track One in person HSTrack Two In Home HS
Payment Options: *

Payment in Full ($610 Tuition. $50 Registration & Book Fee. $60 Security Fee)Three Equal PaymentsPayment in Full - 2 ChildrenThree Equal Payments - 2 ChildrenPayment in Full - 3 ChildrenThree Equal Payments - 3 ChildrenPayment in Full - 4 ChildrenThree Equal Payments - 4 Children
*

I do hereby state that I will pay my child's Hebrew School tuition to Chabad of Bradenton in three equal payments of $240. The first payment will be paid with registration, and each payment following will be paid on or by December 2026 and end by March 2027. Credit Card information or postdated checks must be presented with registration.
Total

$0.00

Payment

Credit Card Check Payment

Postal / Zip Code

Country

Signature:*
Date:*

Month Day Year
Medical Information:
Name of Child's Physician:*
Physician's Phone Number:*

Area Code Phone Number

Physician's Office Address:*

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

Insurance Company Covering the Child*
Policy Number:*
Expiration Date:*

Month Day Year
Please list below any psychological or medical conditions, medications currently being taken, dietary requirements, allergies(include allergies to medications), etc. pertaining to your child.
*

I hereby give permission, in the event of an emergency, for the Director, the Acting Director, or the Teacher at Chabad of Bradenton to take whatever steps maybe necessary for the medical care of my child. I understand that in order for Chabad of Bradenton to assume responsibility for my child, I, or the person(s) whom I have designated to drop off and pick up my child, must sign my child in at the time of arrival and out at the time of departure. I understand that unless there is a need for immediate action, the order of the steps taken will follow, but will not be limited to, the outline below:I give consent to any emergency facility and physician to administer any necessary medical treatment to my child as the situation may warrant it.
1. The parent/Guardian will be called.
Note: If the parent/guardian is unavailable, the emergency contact person designated by the parent/guardian will be called.
2. Child's physician will be called.
3. If these efforts are unsuccessful the following steps will be taken (order may vary depending on the situation):
a. Another physician will be called.
b. The child will be taken to the nearest emergency room accompanied by a staff member.
c. An ambulance will be called to take the child to the nearest emergency room accompanied by a staff member.
In the event of an emergency, if I cannot be reached, I give consent for a Chabad staff member to transport my child to the nearest emergency facility, or to have my child transported by ambulance.
Parent/Guardian's Signature: *
Date:*

Month Day Year
I give consent for my child(ren)’s pictures to be used in all Chabad marketing materials. No names will be used.

YesNo
*

I understand that my registration and security fee is non-refundable.
*

I understand that tuition is non-refundable and there are no refunds or credits for days missed due to illness, holidays, or family vacations. If I choose to withdraw my child from Hebrew School, one month’s written notice is required. Tuition will be refunded on a prorated basis up to February 1, beginning one month after notice is received. After February 1, no refunds will be issued. Families remain responsible for all tuition payments during the one-month notice period, whether or not the student continues attending.
Should be Empty:

First Child

Second Child

Third Child

New Child

Books / Judaic Supplies

Method of Payment:

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