Returning Student Registration Father's Name Mother's Name Email Phone Number Child's Name Child's Main School Does the child have any medical conditions? Yes No If yes, please list them: $100 deposit, per child, is due with registration. The deposit will be deducted from the total tuition. Tuition includes security and book fee. We are members of the shuul: Tuition is $750We are not members of the shuul: Tuition is $850 Credit Card Number Name on Card Expiration Month Expiration Day We grant permission for our child(ren) to be photographed which may be used by the school for PR purposes We grant permission for you to use the payment method on file I hereby give permission, in the event of an emergency, for the Director, the Acting Director, or the Teacher at Chabad Weltman Hebrew School to take whatever steps may be necessary for the medical care of my child. I understand that in order for Chabad Weltman Hebrew School to assume responsibility for my child, I, or the person(s) whom I have designated to drop off and pick up my child, must sign my child in at the time of arrival and out at the time of departure. I understand that unless there is a need for immediate action, the order of the steps taken will follow, but will not be limited to, the outline below: 1. The parent/Guardian will be called. Note:If the parent/guardian is unavailable, the emergency contact person designated by the parent/guardian will be called. 2. Child's physician will be called. 3. If these efforts are unsuccessful the following steps will be taken (order may vary depending on the situation): a. Another physician will be called. b. The child will be taken to the nearest emergency room accompanied by a staff member. c. An ambulance will be called to take the child to the nearest emergency room accompanied by a staff member. In the event of an emergency, if I cannot be reached, I give consent for a Chabad staff member to transport my child to the nearest emergency facility, or to have my child transported by ambulance. I give consent to any emergency facility and physician to administer any necessary medical treatment to my child as the situation may warrant it. Name of parent/guardian filling this form Date Submit
