Hebrew School Registration

New Student Registration
Welcome! We are currently accepting application forms for the 2022-2023 school year. If you have any questions or concerns you'd like to discuss with us, please contact us at 949 770-1270.
Please note that one registration form per child is needed.
We look forward to a wonderful year of learning and growth.
Student Profile
Child's Name*
First NameLast Name
Hebrew Name*
Birth Date*
MonthDayYear
Grade entering as of 09/22*
School*
Previous Jewish Education*
YesNo
Where?
Hebrew Reading Proficiency*
NoneSomewhatWell
CONFIDENTIAL: Does your child have an IEP or other learning challenges? If yes, please describe them and indicate special precautions or care needed.*
Family Information

Address*

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

Father's Name*
First NameLast Name
Father's E-mail*
Father's Cell*
Area CodePhone Number
Mother's Name*
First NameLast Name
Mother's E-mail*
Mother's Cell*
Area CodePhone Number
Are the natural parents and grandparents of the child Jewish by birth?*
YesNo
If no, please explain
Emergency Contact Information
Emergency Contact 1 Full Name*
First NameLast Name
Phone Number*
Area CodePhone Number
Emergency Contact 2 Full Name
First NameLast Name
Phone Number
Area CodePhone Number
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.*
As the parent(s) or legal guardian of the above child, I/we authorize any adult acting on behalf of the CJC Hebrew School to hospitalize or secure treatment for my child, I further agree to pay all charges for that care and/or treatment. It is understood that if time and circumstances reasonably permit, the CJC Hebrew School personnel will try, but are not required, to communicate with me prior to such treatment. I hereby give permission for my child to participate in all school activities, join in class and school trips on and beyond school properties and allow my child to be photographed while participating in the CJC Hebrew School activities and that these pictures may be used for marketing purposes.
I Accept*
Yes
Full Name*
First NameLast Name
We look forward to a wonderful year of learning and growth!
Security Investment; A $125 security investment fee per family will be added to your invoice to help cover the cost of our additional security services.
Choices: Choose all that apply
Hebrew School Younger & Older Division (grades K-7), $845 + $100 Registration + $35 Book
$980
CTeeN (grades 7-12), $625 + $100 Registration
$725
Bar Mitzvah Discovery Course
$300
Bat Mitzvah Discovery Course
$300
Payment Plan
Payment Options*
Pay in full before or on 9/1/2022Pay in two installments 9/1/2022 and 1/1/2023Pay in 9 equal payments, beginning September 1st ending May 1st
Payment Method*
Check Option: I will setup automatic bill pay with my bank to send bank check to Chabad of Mission ViejoCredit Card Option: Charge my credit card. I understand that there is a 3% surcharge to cover the service fee
Total
$0.00

I would like to pay today: Full amount$100.00 minimum $

Payment*

Credit Card Paypal Other

Postal / Zip Code

Country

Should be Empty:

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New Student Registration

Student Profile

Family Information

Emergency Contact Information

Choices: Choose all that apply

Payment Plan