ApplicationPlease enable JavaScript in your browser to complete this form.1CHA NEW STUDENT APPLICATION FOR ADMISSION2STUDENT INFORMATION 3PARENT INFORMATION4FINANCIAL INFORMATION 5ENROLLMENT CONTRACTApplying to: *Infant CarePreschoolElementaryMiddle SchoolPreschool: *18m/2 Year2/3 Year Old3/4/5 Year Old ProgramElementary School: *Kindergarten1st Grade 2nd Grade3rd Grade4th Grade5th GradeMiddle School: *6th Grade7th Grade8th GradeHonorsNextStudent’s Full Name: *FirstMiddleLastGender: *MaleFemaleHebrew Name (if known):Date of Birth *Place of Birth:Age:Language(s) spoken at home:Home Address:Address Line 1CityState / Province / RegionPostal CodeAfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBolivia (Plurinational State of)Bosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongoCongo (Democratic Republic of the)Cook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFalkland Islands (Malvinas)Faroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHondurasHong KongHungaryIcelandIndiaIndonesiaIran (Islamic Republic of)IraqIreland (Republic of)Isle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea (Democratic People's Republic of)Korea (Republic of)KuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesia (Federated States of)Moldova (Republic of)MonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth Macedonia (Republic of)Northern Mariana IslandsNorwayOmanPakistanPalauPalestine (State of)PanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint Martin (French part)Saint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint Maarten (Dutch part)SlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwazilandSwedenSwitzerlandSyrian Arab RepublicTaiwan, Province of ChinaTajikistanTanzania (United Republic of)ThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited Kingdom of Great Britain and Northern IrelandUnited States Minor Outlying IslandsUnited States of AmericaUruguayUzbekistanVanuatuVatican City StateVenezuela (Bolivarian Republic of)Viet NamVirgin Islands (British)Virgin Islands (U.S.)Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland IslandsCountryHome Phone: *Family E-mail: *CURRENT SCHOOLName of School:Dates of AttendanceAddressName of School District: Principal/Head:School Phone Number:Current Teacher: E-mail Address:SCHOOLS PREVIOUSLY ATTENDEDName of School: Dates of Attendance: Name of School: Dates of Attendance:How would you describe your child’s academic performance to date? *How would you describe your child’s personality?Has your child ever received educational support or tutoring outside the school setting? *If so, please explain?Is there a significant incident, major event or experience (relocation, change in the family, loss of a loved one) that has occurred during your child’s lifetime that may help us better understand your child?Has a previous school recommended: *occupational therapyspeech therapyeducational therapyeducational evaluation (ie. IEP testing)N/APlease attach report here: Click or drag files to this area to upload. You can upload up to 5 files. List any delays that your child may be experiencing in the areas of social, emotional, physical or language development:Does your child have specific dietary restrictions, allergies or other health concerns that require special attention? *YESNO(if yes, please describe)Does your child take pescribed medications on a regular basis: *YESNO(if yes, please describe)Add Second Child?YesNoStudent Information (Two)Applying to: *Infant CarePreschoolElementaryMiddle SchoolPreschool: *18m/2 Year2/3 Year Old3/4/5 Year Old ProgramElementary School: *Kindergarten1st Grade2nd Grade3rd Grade4th Grade5th GradeMiddle School: *6th Grade7th Grade8th GradeHonorsStudent’s Full Name: *FirstMiddleLastGender *MaleFemaleHebrew Name (if known):Date of Birth *Place of Birth:Age:Language(s) spoken at home:Home Address:Address Line 1Address Line 2CityState / Province / RegionPostal CodeAfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBolivia (Plurinational State of)Bosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongoCongo (Democratic Republic of the)Cook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFalkland Islands (Malvinas)Faroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHondurasHong KongHungaryIcelandIndiaIndonesiaIran (Islamic Republic of)IraqIreland (Republic of)Isle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea (Democratic People's Republic of)Korea (Republic of)KuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesia (Federated States of)Moldova (Republic of)MonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth Macedonia (Republic of)Northern Mariana IslandsNorwayOmanPakistanPalauPalestine (State of)PanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint Martin (French part)Saint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint Maarten (Dutch part)SlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwazilandSwedenSwitzerlandSyrian Arab RepublicTaiwan, Province of ChinaTajikistanTanzania (United Republic of)ThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited Kingdom of Great Britain and Northern IrelandUnited States Minor Outlying IslandsUnited States of AmericaUruguayUzbekistanVanuatuVatican City StateVenezuela (Bolivarian Republic of)Viet NamVirgin Islands (British)Virgin Islands (U.S.)Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland IslandsCountryHome Phone: EmailCURRENT SCHOOLName of School:Dates of Attendance:AddressName of School District:Principal/Head:School Phone Number:Current Teacher:E-mail Address: SCHOOLS PREVIOUSLY ATTENDEDName of School:Dates of Attendance:How would you describe your child’s academic performance to date? *How would you describe your child’s personality?Has your child ever received educational support or tutoring outside the school setting? *If so, please explain?Is there a significant incident, major event or experience (relocation, change in the family, loss of a loved one) that has occurred during your child’s lifetime that may help us better understand your child?Has a previous school recommended: *occupational therapyspeech therapyeducational therapyeducational evaluation (ie. IEP testing)N/APlease attach report here: Click or drag files to this area to upload. You can upload up to 5 files. List any delays that your child may be experiencing in the areas of social, emotional, physical or language development:Does your child have specific dietary restrictions, allergies or other health concerns that require special attention? *YesNo(if yes, please describe)Does your child take pescribed medications on a regular basis: *YesNo(if yes, please describe)PreviousNextPARENT ONE:Name *FirstLastTitle: Home Address:(if different from Student):Address Line 1CityState / Province / RegionPostal CodeAfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBolivia (Plurinational State of)Bosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongoCongo (Democratic Republic of the)Cook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFalkland Islands (Malvinas)Faroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHondurasHong KongHungaryIcelandIndiaIndonesiaIran (Islamic Republic of)IraqIreland (Republic of)Isle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea (Democratic People's Republic of)Korea (Republic of)KuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesia (Federated States of)Moldova (Republic of)MonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth Macedonia (Republic of)Northern Mariana IslandsNorwayOmanPakistanPalauPalestine (State of)PanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint Martin (French part)Saint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint Maarten (Dutch part)SlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwazilandSwedenSwitzerlandSyrian Arab RepublicTaiwan, Province of ChinaTajikistanTanzania (United Republic of)ThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited Kingdom of Great Britain and Northern IrelandUnited States Minor Outlying IslandsUnited States of AmericaUruguayUzbekistanVanuatuVatican City StateVenezuela (Bolivarian Republic of)Viet NamVirgin Islands (British)Virgin Islands (U.S.)Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland IslandsCountryHome Phone:Cell: *Email: *Place of Employment:Business Address:Address Line 1CityState / Province / RegionPostal CodeAfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBolivia (Plurinational State of)Bosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongoCongo (Democratic Republic of the)Cook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFalkland Islands (Malvinas)Faroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHondurasHong KongHungaryIcelandIndiaIndonesiaIran (Islamic Republic of)IraqIreland (Republic of)Isle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea (Democratic People's Republic of)Korea (Republic of)KuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesia (Federated States of)Moldova (Republic of)MonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth Macedonia (Republic of)Northern Mariana IslandsNorwayOmanPakistanPalauPalestine (State of)PanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint Martin (French part)Saint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint Maarten (Dutch part)SlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwazilandSwedenSwitzerlandSyrian Arab RepublicTaiwan, Province of ChinaTajikistanTanzania (United Republic of)ThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited Kingdom of Great Britain and Northern IrelandUnited States Minor Outlying IslandsUnited States of AmericaUruguayUzbekistanVanuatuVatican City StateVenezuela (Bolivarian Republic of)Viet NamVirgin Islands (British)Virgin Islands (U.S.)Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland IslandsCountryProfession:Positon /Title:Work Phone:PARENT TWO:NameFirstLastTitle:Home Address:(if different from student):Address Line 1CityState / Province / RegionPostal CodeAfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBolivia (Plurinational State of)Bosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongoCongo (Democratic Republic of the)Cook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFalkland Islands (Malvinas)Faroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHondurasHong KongHungaryIcelandIndiaIndonesiaIran (Islamic Republic of)IraqIreland (Republic of)Isle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea (Democratic People's Republic of)Korea (Republic of)KuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesia (Federated States of)Moldova (Republic of)MonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth Macedonia (Republic of)Northern Mariana IslandsNorwayOmanPakistanPalauPalestine (State of)PanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint Martin (French part)Saint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint Maarten (Dutch part)SlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwazilandSwedenSwitzerlandSyrian Arab RepublicTaiwan, Province of ChinaTajikistanTanzania (United Republic of)ThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited Kingdom of Great Britain and Northern IrelandUnited States Minor Outlying IslandsUnited States of AmericaUruguayUzbekistanVanuatuVatican City StateVenezuela (Bolivarian Republic of)Viet NamVirgin Islands (British)Virgin Islands (U.S.)Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland IslandsCountryHome Phone:Cell:Email:Place of Employment:Business Address:Address Line 1CityState / Province / RegionPostal CodeAfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBolivia (Plurinational State of)Bosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongoCongo (Democratic Republic of the)Cook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFalkland Islands (Malvinas)Faroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHondurasHong KongHungaryIcelandIndiaIndonesiaIran (Islamic Republic of)IraqIreland (Republic of)Isle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea (Democratic People's Republic of)Korea (Republic of)KuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesia (Federated States of)Moldova (Republic of)MonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth Macedonia (Republic of)Northern Mariana IslandsNorwayOmanPakistanPalauPalestine (State of)PanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint Martin (French part)Saint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint Maarten (Dutch part)SlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwazilandSwedenSwitzerlandSyrian Arab RepublicTaiwan, Province of ChinaTajikistanTanzania (United Republic of)ThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited Kingdom of Great Britain and Northern IrelandUnited States Minor Outlying IslandsUnited States of AmericaUruguayUzbekistanVanuatuVatican City StateVenezuela (Bolivarian Republic of)Viet NamVirgin Islands (British)Virgin Islands (U.S.)Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland IslandsCountryProfession:Position/Title:Work Phone:Family InformationWhat expectations do you have of our program for your child/ren?Total number of children in family:Name:Age:Sex:MaleFemalePresent School :Name :Age: Sex: MaleFemalePresent School : Name : Age: Sex:MaleFemalePresent School :Was your child adopted:YESNOPlease list names and relationships of any friends/relatives who have attended Chabad Hebrew AcademyApplicant Lives With: *Synagogue Affiliation: *Who referred you to the Chabad Hebrew Academy? PLEASE NOTE: Chabad Hebrew Academy receives more applications for admission than we can accommodate. The school attempts to admit students in the order that their applications are received. In order to be processed, all forms must be complete and must be accompanied by the $600 application fee. PreviousNextSCHEDULE OF TUITION, FEES AND OTHER CHARGES Infant Tuition $18,900.00Monday - Thursday 8:00 a.m. - 5:30 p.m. Friday 8:00 a.m. - 4:30 p.m.Preschool $14,800.00Mon - Thurs. - 8am - 3:30pm Fri 8 am-2:30 pm Before/Aftercare Available Elementary- Grade K-5$23,119.43Mon - Thurs. - 8am - 3:30pm Fri 8 am-2:30 pm Before/Aftercare AvailableMiddle School - Grade 6-8$24,425.89Mon - Thurs. - 8am - 3:30pm Fri 8 am-2:30 pm Before/Aftercare AvailableTuition Discounts: Chabad Hebrew Academy offers tuition discounts to students who fall into the following categories: Families who enroll three or more students in Chabad Hebrew Academy will receive a 20% multiple child discount on the tuition of the third and fourth child. Each child enrolled beyond the fourth child will receive a 50% tuition discount. The discount will be deducted from the youngest child/ren’s tuition. Preschool/Infant program not included. Financial Aid: (K-8 ONLY) Financial Aid is available on a limited basis. Please apply through our partner FACTS Management. In order to qualify for financial aid, this application form and the above financial aid application must be completed. Families of applying students will be notified as soon as possible regarding their financial aid grant. If the applicant does not receive a scholarship, the $600 application fee will be returned. NOTE: Infant and Preschool are not eligible for financial aid. Financial AidApply for Financial Aid - https://online.factsmgt.com/signin/48JJS Note: Assistance is Only Available K-8 Request Limited Tuition AssistancePAYMENT SCHEDULE Option 1: Pay in Full : The full year’s tuition is paid upon enrollment. Families who elect this will receive an additional 1.5% discount. Direct payment can be made to CHA by check or credit card. A 3% additional charge will be made to those who pay by credit card. Option 2 :Three installments: One third of the total tuition is to be made directly to CHA. The 2 remaining payments of May and November will be processed by FACTS. Enrollment in a FACTS Payment account, is mandatory to complete the application. https://online.factsmgt.com/signin/48JJS Option 3: 10 installments: The first payment of 1/10th of the total amount is made directly to CHA. The 9 remaining payments from March through November will be processed by FACTS. Enrollment in a FACTS tuition account is mandatory to complete the application. https://online.factsmgt.com/signin/48JJSPayment Schedule *Option 1Option 2Option 3Information for Option 2 and 3: 1. Please create a Tuition Payment Plan through FACTS and select “Create username & password”. https://online.factsmgt.com/signin/48JJS 2. Then click on the Set Up a Payment Plan button or Start Application button for the appropriate school year. 3. Complete the steps as prompted. PreviousNextENROLLMENT CONTRACT DETAILSAll tuition is payable in advance unless the parent has made arrangements to participate in the FACTS three payment or ten payment plan. Enrollment is for the academic year ahead. Tuition payments must begin by February of the preceding school year. Enrollment is on a continual basis. Enrollment shall be in effect from the date of enrollment and shall renew automatically for each successive academic year until graduation unless and until the agreement is terminated by CHA or written notice of termination is received in the CHA Finance Office The student's billing account will be charged the enrollment fee for the following school year on February 1st of each year unless said written notice of termination has been returned to the Admissions office. Students who do not submit the enrollment fee by the deadline as specified or who have notified the Admissions office of termination of continuous enrollment may lose their space for the subsequent year as new applicants are accepted. Enrollment fees unpaid after the stated enrollment deadline will be treated as a new application and new admission fees will be required in addition to the enrollment fee. Continuous enrollment is not a right. Enrollment may be denied, at the sole discretion of CHA. The application fee and first tuition payment will be drawn from your FACTS account on January 31st, each year as a down payment on the upcoming year’s tuition. To cancel enrollment for the upcoming school year, a parent or guardian must inform the Business Office in writing by January 31. If a parent or guardian cancels enrollment afterward, the down payment will be non-refundable. The annual January down payment may be refunded in the event of unique circumstances, such as a family relocating from San Diego or withdrawal at the request of CHA. Other unique circumstances may be presented to the Head of School and Business Office for consideration on a case-by-case basis. Enrollment is not considered final, until arrangements for payment of tuition and fees have been finalized, and this contract has been signed by the family and a representative of Chabad Hebrew Academy. For your convenience, CHA utilizes FACTS for tuition collection services. All families electing to pay for school tuition in more than one payment must have a completed & active FACTS account before admission is considered final. If any changes of account information are required, please notify the CHA Business Office. Non-Refundability: I/We agree to notify the School in writing if, at any time, I/we decide not to enroll the Student or decide to withdraw the Student from the School. I/We understand that in the event that the Student does not enroll or does not complete the academic year, costs incurred by the school based on the assumption of Student’s attendance, do not diminish. Hence, if, at any time, after the date of this Enrollment Agreement, for any reason, I/we decide not to enroll the Student, the Student’s enrollment is terminated, or the Student is either voluntarily or involuntarily withdrawn from the School, I/we agree that: 1) I/We will not be entitled to a refund of any amounts designated as non-refundable. 2) If written notice is given after May 1, of the preceding academic year, I/we will be obligated to pay the entire tuition. Default: Upon any breach of our obligations under this Enrollment Agreement, I/we agree that the School may accelerate the balance due under the terms of this Enrollment Agreement, enforce its rights, suspend the Student’s enrollment, and prohibit the student from attending classes and/or participating in school activities. I understand that transcripts and other official records cannot be released by the School if tuition or fees are in arrears. Release: To the fullest extent permitted by law, I/we, on behalf of myself/ourselves and on behalf of the Student, hereby release and hold the School, its agents, and employees harmless from all claims, damages or other liabilities for injuries to the Student, his parents, or legal guardians, which are not the result of gross negligence by the School, its agents, or employees. The Student, his parents, or legal guardian also hereby agree to indemnify and hold the School harmless for any damages incurred by the School or any third party as a result of actions taken by the Student or his parents or legal guardian. Automatic FACTS Re-enrollment. For your convenience, the original contract you signed with FACTS authorizes FACTS to continue processing payments upon receipt of your re-enrollment. The annual $50 FACTS processing fee will be charged to your FACTS account. Initial to agree to the above:Initial here: *Tuition & Fees Application Fee (Non-Refundable) $600 *Price: $ 600.00 Application Fee (Non-Refundable) $600 (2nd Child) *Price: $ 600.00 Infant Tuition $18,900 In Full Infant Tuition $6,300.00 x 3 Installments Infant Tuition $1,890 x 10 Installments Preschool $14,800.00 In Full Preschool $4,933.33 x 3 Installments Preschool $1,480.00 x 10 Installments Elementary Grade K-5 $23,119.43 In Full Elementary Grade K-5 $7,706.48 x 3 Installments Elementary Grade K-5 $2,311.94 x 10 Installments Middle School Grade 6-8 $24,425.89 In Full Middle School Grade 6-8 $8,141.96 x 3 Installments Middle School Grade 6-8 $2,442.59 x 10 Installments Infant Tuition (2nd Child) $18,900 In Full Infant Tuition (2nd Child) $6,300.00 x 3 Installments Infant Tuition (2nd Child) $1,890.00 x 10 Installments Preschool (2nd Child) $14,800.00 In Full Preschool (2nd Child) $4,933.33 x 3 Installments Preschool (2nd Child) $1,480.00 x 10 Installments Elementary Grade K-5 (2nd Child) $23,119.43 In Full Elementary Grade K-5 (2nd Child) $7,706.48 x 3 Installments Elementary Grade K-5 (2nd Child) $2,311.94 x 10 Installments Middle School Grade 6-8 (2nd Child) $24,425.89 In Full Middle School Grade 6-8 (2nd Child) $8,141.96 x 3 Installments Middle School Grade 6-8(2nd Child) $2,442.59 x 10 Installments Security Fee (Per Family) $180.00 Long Range Planning and Facilities Fee. Fully Tax Deductible (Per Family) $500.00 Technology Financing Fee $250.00 Application Fee Due at This Time:$ 0.00I/We agree to pay the application fee by: *Check Credit CardCredit CardCard NumberSecurity CodeName on CardExpirationMM123456789101112/YY2425262728293031323334Comment:LEGAL SIGNATURE By signing this application, I/we hereby acknowledge that all the information provided is accurate and complete. Omissions or inaccurate information may be grounds for dismissal if a student has been accepted. By signing this application, I/We agree to be bound by the stated terms and conditions, and I/We hereby acknowledge that all the information provided is accurate and complete. I/We agree to pay all tuition and fees as stated. Signature of Parent or Legal Guardian Date *Clear SignatureSignature of Parent or Legal Guardian Date Clear SignaturePreviousSubmit