Register Online - New Students

Student Profile
Student's Name*
First Name Last Name
Hebrew Name*
Age*
Birth Date*

Month Day Year
Approx time of birth* Helps determine child's Jewish Birthday
Hour Minutes
Gender*

MaleFemale
Grade Entering*
Does your child have an IEP? * If yes, please email it in.

YesNo
Please tell us about your child * Their special interests, their likes or dislikes, how your child learns best, etc.
Additional notable Information* Please let us know if there are any other important information we need to be aware of.
CONFIDENTIAL: Does your child have any allergies or medical conditions?* If yes, please describe them and indicate special precautions or care needed.
Family/Parent Information
Marital Status*
Mother's Name*
First Name Last Name
Mother's Hebrew Name*
Mother's Mobile*
Mother's Email*

Address*

Address (if different)

Address

Address

E-mail
Phone Number
Emergency Contact Info
Full Name*
First Name Last Name
Relationship to the child*
Phone Number*
*

In the event I cannot be reached, I hereby grant permission to the staff of CHS to treat and/or provide a physician or hospital to give emergency treatment to my child
Tuition
Register my child*

$360 + 36 book fee
Optional Sponsorship for the education of another child

$100$180$360
Total

$0.00

Payment*

Credit Card

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

Billing Address

Street Address

City

State / Province

Postal / Zip Code

Country

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Updates

Looking forward to a wonderful year!

Student Profile