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 |
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Child 2 |
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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.