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Student Information
CHILD 1
Last Name
 
 
 First Name
Hebrew Name
Gender
Male Female		 Date of Birth
School
Grade
Previous Jewish education?
Yes No		 If Yes please describe
Medical challenges or allergies? 
Yes No		 If Yes please explain
 
CHILD 2
Last Name
 
 
 First Name
Hebrew Name
Gender
Male Female		 Date of Birth
School
Grade
Previous Jewish education?
Yes No		 If Yes please describe
Medical challenges or allergies?
Yes No		 If Yes please explain
 
CHILD 3
Last Name
 
 
 First Name
Hebrew Name
Gender
Male Female		 Date of Birth
School
Grade
Previous Jewish education?
Yes No		 If Yes please describe
Medical challenges or allergies?
Yes No		 If Yes please explain
 
Parent Information
Marital Status
Affiliation
 
Parent 1
Title/First Name
Last Name
 
 
 Work Phone
Cell Phone
 
 
 Email 

Jewish  Yes  No
Converted  Yes  No
Parent 2
Title/First Name
Last Name
Work Phone
Cell Phone
 
 
 Email 
 Jewish  Yes  No
Converted  Yes  No
Parents
Address
City/State/ Zip
Home Phone
Emergency Information
Emergency 1
Name
Phone #
 
 
 Relation
Emergency 2
Name
Phone #
 
 
 Relation
Tuition Fees

Classes are held on Monday afternoons at Chabad Jewish Center of Petaluma 3:30-5:00 pm

Rate A: $750.00  |  Rate B: $650  |  Child Two - 10% Off
Scholarships

Every Jewish child deserves a quality education. Contact us at 707.559.8585 and we will be glad to help.

If you are in the position to contribute to the scholarship fund, please consider doing so below.
 $180      Half Scholarship - $325      Full Scholarship - $650       Other amount $ 
Payment Information
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Please Choose Payment Method
Card Number
 
 
 Name on Card
Expiration Date
Security Code
What's This? Billing Address
Billing Zip

- Enrollment and acceptance in Petaluma Hebrew is in not a certification of Jewish status - 

 

 

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Registration
Now accepting registration for 2020-2021
Fill out the online registration form here
Petaluma Hebrew Pods! Contact for details
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