Printed from ChabadSugarland.com

Registration Form

Registration Form

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                                                                                                                                                   B”H

CHABAD TEEN CLUB

SUGAR LAND, TEXAS

4501 Cartwright Rd. #770 Missouri City, TX 77459 (832)758-0685

www.chabadsugarland.com

Registration Application

 

Last name:_______________________________

First name:

 

                     English                           Hebrew                     Age              Date of birth            Grade entering

 

Child 1

 

Child 2

 

Child 3



 

 

Mailing address

 

____________________________         __________          ______________

Address                                                                               City                                   Postal code

 

Phone No.______________________

E-mail address__________________________

 

Non registered children

 

Name_________________________ Age________               Name_________________________ Age___

 

Parent information

 

Father’s name: ____________      _______________     Business or Profession_______________________

                         English                  Hebrew

Business name:__________________________Business number__________________________________

Business address:________________________________________________________________________

 

Mother’s name:____________       _____________        Business or Profession______________________

                         English                   Hebrew

Business name:__________________________ Business number_________________________________

Business address:________________________________________________________________________

 

Mother’s maiden name:_________________________

 

Synagogue with which family is affiliated:_________________________

                                                                                                                                                        B”H

Registration Application    (page 2)

 

 

Does your child/ren read basic Hebrew yet?

                                                                                      (Please circle one)

Child 1________________________Age____  No    Poor      Fair       Good

 

Child 2________________________Age____ No     Poor      Fair       Good

 

Child 3________________________ Age____ No    Poor      Fair       Good

 

Does your child have any learning difficulties with general studies?_______

 

 

 

Is there any special medical or other information regarding your child/ren which our school should be aware of?_______________________________

_____________________________________________________________

 

 

 

Please list two numbers to be used in case of emergencies

 

Name_____________________ Relationship____________ Tel__________

 

Name_____________________ Relationship____________ Tel__________

 

I hereby permit my child/ren to participate in all school activities, join in class and school trips on and beyond school properties.  In case of an emergency, I hereby authorize the school to have my child/ren taken care of by a physician in any way the situation may call for.

 

Signature of Parent or Guardian _____________________ Date _________

 

Annual tuition-$350 per child.

 
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