Registration - ChabadVenetian.com

Child 1's Information

Child's Name*

First Name Last Name Hebrew Name

Gender*

Male Female

Age*

Date of Birth*

Month Day Year

at Hour Minutes

Registering For* See below for pricing

Full day program Monday - Thursday 9:00am - 3:30pm, Friday 9:00 am - 12:45 pm Half day program Monday - Friday 9:00am - 12:45pm.

Comments / Notes

Child 2's Information

Child's Name

First Name Last Name Hebrew Name

Gender

Male Female

Age

Date of Birth

Month Day Year

at Hour Minutes

Registering For* See below for pricing

Full day program Monday - Thursday 9:00am - 3:30pm, Friday 9:00 am - 12:45 pm Half day program Monday - Friday 9:00am - 12:45pm.

Comments / Notes

Parent's Information

Father's Name*

First Name Last Name

Father's Cell*

Area Code Phone Number

Father's Email*

Mother's Name*

First Name Last Name

Mother's Cell*

Area Code Phone Number

Mother's Email*

Address*

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

Home Phone*

Area Code Phone Number

Is the natural mother of the child Jewish?

Yes No

If no, please explain.

Is the natural maternal grandmother of the child Jewish?

Yes No

If no, please explain.

Have there been any conversions or adoptions in the family?

Yes No

If yes, please explain.

My Child is a

Emergency Information

Emergency Contact 1*

First Name Last Name

Emergency Contact 1 Phone*

Area Code Phone Number

Emergency Contact 1 Relationship*

Emergency Contact 2*

First Name Last Name

Emergency Contact 2 Phone*

Area Code Phone Number

Emergency Contact 2 Relationship*

Family Physician*

Family Physician Phone*

Area Code Phone Number

CONFIDENTIAL: Does your child have any allergies or other medical condition we should be aware of? If yes, please describe them and indicate special precautions or care needed.

Payment Information

Full day Tuition fee: $9,500 per year

Half day tuition fee: $7,500 per year

Registration fee: $500, must be paid at time of registration with credit card

*Contact us for a 10% sibling discount

Pay in full and receive 5% discount at a total price of

$9,025 for full day - one child $7,125 for half day - one child $18,050 for full day - two children $14,250 for half day - two children $16,150 for one child full day and one child half day

Would like to pay monthly by

Credit Card Check

Checks should be submitted in person or mailed to :
Gan Chabad
14 Farrey Lane
Miami Beach, FL 33139

Submit head checks dated August 1, 2022 - May 1, 2023

Monthly Checks*

One child - $950 for full day. $750 for half day. Two children - $1900 for full day, $1500 for half day. $1700 for one child full day and one child half day

Charge my card monthly starting August 1, 2022- May 1, 2023*

$950 for full day - one child $750 for half day - one child $1900 for full day - two children $1500 for half day - two children $1700 for one child full day and one child half day

Registration Fee*

$500 one child $1000 two children

Total

$0.00

Payment

Credit Card

Credit Card Type
Credit Card Number	Security Code
Name on Card
Expiration Month	Expiration Year

Billing Address

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Country

Terms of Agreement

Terms of Agreement*

I agree that in the event of an emergency, Gan Chabad has my permission to arrange for any necessary first-aid or care by a licensed physician/first-aid worker. Gan Chabad has my permission to use my child's photo in its publicity materials. I give permission for my child to attend all field trips and outings part of Gan Chabad. I have completed the Enrollment Form and agree to pay any balance according to the terms of agreement outlined above.

I would like to receive news and updates by email

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