Registration Form 2026

Child(ren)'s Information
How many children are you registering?*
1. Full Name*
First Name Last Name
Birth Date*

Month Day Year
Grade*
2. Full Name
First Name Last Name
Birth Date

Month Day Year
Grade
3. Full Name
First Name Last Name
Birth Date

Month Day Year
Grade

Address*

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

Parent's Information
Mother's Name*
First Name Last Name
Phone Number*

Area Code Phone Number
E-mail*
Father's Name*
First Name Last Name
Phone Number*

Area Code Phone Number
E-mail*
I would like to receive news and updates by email
Is the natural mother of the child Jewish?*

YesNo
Any conversions in the family? *

YesNo
If yes, please specify:
Please Note: Acceptance into Hebrew School does not confirm Jewish status.*

Noted
Medical Information
Is your child currently taking any medication?*

YesNo
Does your child have any allergies?*

YesNo
If yes, please provide any additional relevant information. (If signing up more than one child, please specify whom.)
Is there any medical or other information that we should be aware of?**

YesNo
If yes, please describe.
Emergency Contact #1*
First Name Last Name
Emergency Contact #1 Phone*

Area Code Phone Number
Emergency Contact #2*
First Name Last Name
Emergency Contact #2 Phone*

Area Code Phone Number
Please note: submission of this form does not guarantee acceptance. All applications are subject to review and confirmation.*

Noted
Payment Information
Jewish After School Tuition

Tuition: $1,800 per child

There is a $50 registration fee, charged at registration. This fee will be applied toward tuition.
I am signing up*

One Child = $1,800Two Children = $3,600Two Children = $5,400
I would like to pay the tuition:*

All at once on the first day of The Jewish After SchoolWith monthly installments (Sep-May). The payments will be processed automatically every month with the credit card you will provide below.

Payment

Credit Card

We accept Visa, MasterCard, American Express, Discover
Credit Card Number	Security Code
Name on Card
Expiration Month	Expiration Year

Billing Address

Street Address

City

State / Province

Postal / Zip Code

Country

Total

$0.00
As the parent(s) or legal guardian of the above child, I/we authorize any adult acting on behalf of Chabad of South Pasadena or The Jewish After 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 South Pasadena or The The Jewish After 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 Neighborhood Hebrew School activities and that these pictures may be used for marketing purposes. The Jewish After School is a program under Chabad of South Pasadena and reserves the right to terminate this registration at any time and refund the balance paid.
*

I Accept
Name*
My e-signature will be legally binding as a printed signature
Should be Empty:

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● Registration Form 2026

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