Hebrew School Registration

Number of Children Registering
Child's Information
Full Name*
First NameLast Name
Hebrew Name*
Birth Date*
MonthDayYear
School*
Grade Entering 2023/24*
Previous Jewish Education?*
YesNo
Does child have an IEP?*
YesNo
Please briefly explain IEP
Allergies or other known conditions*
Child #2
Full Name #2*
First NameLast Name
Hebrew Name #2*
Birth Date #2*
MonthDayYear
School #2*
Grade Entering 2023/24 #2*
Previous Jewish Education? #2*
YesNo
Does Child #2 have an IEP?*
YesNo
Please briefly explain IEP
Allergies or other known conditions #2*
Child #3
Full Name #3*
First NameLast Name
Hebrew Name #3*
Birth Date #3*
MonthDayYear
School #3*
Grade Entering 2023/24 #3*
Previous Jewish Education? #3*
YesNo
Does Child #3 have an IEP?*
YesNo
Please briefly explain IEP
Allergies or other known conditions #3*
Parent's Information
Mother's Name*
First NameLast Name
Hebrew Name*
Mother's Cell*
Area CodePhone Number
Mother's E-mail*
Is mother Jewish?*
YesNo
Father's Name*
First NameLast Name
Hebrew Name*
Father's Cell*
Area CodePhone Number
Father's E-mail*
Is father Jewish?*
YesNo

Address*

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

General Information
Has anyone in the family converted or been adopted?*
YesNo
Please share details (ie who, which officiating Beth Din etc)
Names and ages of other children
Congregation Membership (if any)
The following people are authorized to take my child from school:
Full Name*
First NameLast Name
Full Name*
First NameLast Name
Does either parent have any special skill or resource to offer our children or teachers?
How did you hear about WCHS?
OnlineMailingReferral
Referred by:
Emergency 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
Pediatrician
Full Name*
First NameLast Name
Phone Number*
Area CodePhone Number
Permissions
If parents can not be reached and emergency medical advice is needed, permission is granted to contact my child's doctor
In case of medical emergency requiring immediate emergency care, I authorize transportation to nearest medical facility
I authorize Chabad of Wilmette and its agents to involve our child in various trips and activities, direct you to rely upon the registration forms previously tendered for emergency contact persons for the benefit of our child[ren], authorize the administration of any medicines deemed necessary by emergency health professionals in the event of non-availability of parent/guardian, acknowledge that all known allergies or other conditions impacting the health and well being of our child[ren] are listed above, and further release the School and its agents from liability arising during the course of these various field trips and activities.
I/we understand that my/our child[ren] may be included in photographs and video footage that may be photographed or filmed during Hebrew School. I authorize the WCHS and Chabad of Wilmette to use these photos/videos to promote its programs and services in print, web, and other promotional contexts.
I/we understand that as part of my transporting my child to and from the school, I /we will not park on Thelin Court or make u-turns on either Thelin Court or Old Glenview Road. I will follow all instructions given by the security guard or traffic monitor.
Payment Information
The annual fee for one student at WCHS is $950, with a $100 registration fee (that is waived if the child is registered before June 1).
A minimum initial payment of $350 per child is required at the time of registration. If this option is selected, the remaining balance will be automatically processed on December 1.
If you have made alternative payment arrangements with the director, please select 'Check or Special Arrangment'.
Total
$0.00

I would like to pay today: Full amount36.8421053% minimum: $0.00 $
Optional : I'm aware that there are students on scholarship. I'd like to contribute this additional amount towards the tuition of a fellow student in need.
$50$350$950

Payment

Credit Card Paypal Check or Special Arrangement

Postal / Zip Code

Country

Should be Empty:

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Child's Information

Child #2

Child #3

Parent's Information

General Information

Emergency Information

Permissions

Payment Information