Tzohar - Israeli After School Registration Form

We appreciate very much your investment in Jewish education.

Please use this form to register your child(ren) for our program.
The registration is not confirmed until we receive your payment. Thank you.

How many people are you registering? *

(including yourself)

Child & Parent Information

First Child First Name *

First Child's Last Name *

First Child Date of Birth (MM/DD/YYYY) *

School your child will be attending in 2023-24 year *

What grade your child will be in 2023-24 school year *

Age Group to Join

Gender *

Female Male

What is your child's level of knowledge of Hebrew? *

Fluent in speech, reading and writing

Fluent in speech only / No reading and writing

Other

If your first child has any allergy or other medical concerns, please specify here.

I declare that I marked the correct option for the first child. *

I am not aware of any health restrictions that prevent my son/daughter from participating in activities on the "Tzahar" program and on his/her behalf.

My son/daughter has health limitations that prevent full/partial participation in and on behalf of "Tzahar" activities.

Parent's name (Primary Contact) *

Phone Number *

Contact email address *

Street Address *

City *

State *

Postal Code *

Second Parent's name

Second Parent's Phone Number

Second Parent's email

I understand that the registration is for the full year and I am responsible to pay $9000 over 10 month. *

Yes No

Please comment here if you have any additional questions or concerns.

Registration

Tzohar Tuition Fees *

tzohar - $ 900.00

Total for this participant

Authorize.net (Credit Card)

Card Type

Card Number *

Security Code *

Expiration Date *

My billing address is the same as above

Billing Name and Address

Billing First Name *

Billing Middle Name

Billing Last Name *

Street Address *

City *

Country *

State/Province *

Postal Code *

If you can, please consider adding a donation by clicking here. This will help us serve you better.

Tzohar After School Israeli a Program of Chabad Israeli Silicon Valley

1650 Channing Ave Palo Alto, 94303 CA

tzohar@chabadisraeli.org - 650.804.5019 - www.israeliafterschool.com

Chabad of My Town