Chabad of Contra Costa Hebrew School


Registration Form

2019 - 2020

We are currently accepting application forms for the 2019- 2020 school year. Please fill out ALL fields of this form. If you have any questions or concerns you'd like to discuss with us, please Email

At the bottom of the registration form please be sure to fill out the information needed for the $100 deposit, which can be paid online through this secure form.

Please note that one registration form per child is needed.


If your child is already a student in the Chabad Hebrew School you DO NOT need to complete an entirely new application and emergency form.

CLICK HERE and complete the re-registration form (please complete a new form for each child). NOTE: If any information has changed since the last school year (including: physician, change of address, emergency contacts, etc.) it must be listed in the notes of the re-registration form.

Please note: Your child is not registered in the Chabad Hebrew School until you receive a confirmation phone call or email.

We look forward to a wonderful year of learning and growth.

Student Information

First Name Last Name
Hebrew Name D.O.B.
School Grade Entering
Hebrew Reading Proficiency None Somewhat Well
Previous Jewish Education Yes No If yes - Where

Parent Information

Father's Name Father's Cell #
Mother's Name Mother's Cell #
Address City, State, Zip
Home Phone Email Address
Is Father Jewish? Yes No Is Mother Jewish? Yes No
Were there any conversions or adoptions in the family? Yes No
If yes, please explain:

Emergency Information

Emergency Contact 1 Phone #
Emergency Contact 2 Phone #

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 Chabad of Contra Costa 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, Chabad of Contra Costa 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 grounds and allow my child to be photographed while participating in Chabad of Contra Costa Hebrew School activities and that these pictures may be used for marketing purposes.

I Accept

Name: Initials:

Payment Options

Yes, I would like to pay $650.00 (full tuition) for the coming year.

Yes, I would like to pay the deposit of $100.00 now. I will send the remaining tuition balance by Sep 5. The remaining tuition balance can be paid by check, mailed to Chabad of Contra Costa 1671 Newell Ave. Walnut Creek, CA 94595.

Yes, I would like to make a tax deductible contribution to Chabad of Contra Costa Hebrew School Scholarship Fund in the amount of

Name on Card Card Type
Charge Amount Card Number
Exp. Date CVV Code
I will send a check to Chabad of Contra Costa 1671 Newell Ave. Walnut Creek, CA 94595.