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Aleph Academy

Welcome to Aleph Academy, where we're redefining after-school Jewish enrichment. We offer an innovative program for children ages 4 and up, setting the trend in creative Jewish expression and education.

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ב"ה

New Students

Child's Name
First Name Last Name
Birth Date

Month Day Year
Hebrew Name
Hebrew Birthday
School Attending
Current Grade

Address

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

Phone Number
E-mail
Mother's Name (or Guardian)
First Name Last Name
Hebrew Name
Work
Phone Number
E-mail
Father's Name (or Guardian)
First Name Last Name
Hebrew Name
Work
Phone Number
E-mail
Name/s of Siblings
School of Siblings
Siblings Date of Birth
Was the child born Jewish?

YesNo
Were there any conversions or adoptions in the family?

YesNo
If yes, who was the Rabbi?
Additional Comments
Emergency File
Doctor's Name
Allergies
Medical Conditions
Emergency Contact 1
First Name Last Name
Phone Number
Relationship
Emergency Contact 2
First Name Last Name
Phone Number
Relationship
PERMISSION FOR EMERGENCY MEDICAL TREATMENT:

As the parent(s) or legal guardian, I/we authorize any adult acting on behalf of Chabad of the Beaches 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 the Beaches personnel will try, but are not required, to communicate with me prior to such treatment. I hereby give permission for my child to attend all field trips and outings sponsored by Chabad of the Beaches.
Signature
Payment Info
Full Amount $950Ready Set Aleph Bet - PreK/Kindergarten (Free)Standard (Two Installments) $475Ten Monthly Installments (Aug to May) $95
Total

$850.00

Payment

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Postal / Zip Code

Country

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