Registration for Returning Students - Chabad of Homestead & Cutler Bay

Student's Name*
First Name Last Name
Birth Date*

Month Day Year
Age*
Grade Entering*
Parent's Name*
First Name Last Name
E-mail*
Phone Number*
Does your child have an IEP?*

YesNo
Please indicate any changes to your personal/contact information that has changed since last year
TUITION
Please select your payment option*

One-time $360Monthly $40
Preferred payment date:
Mandatory book fee*

$36
Total

$0.00

Payment

Credit Card

Billing Address

Street Address

City

State / Province

Postal / Zip Code

Country

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