Printed from ChabadofLexington.com

Hebrew High

Hebrew High

JOIN THE HIT HEBREW HIGH PROGRAM @ CHABAD OF LEXINGTON!

WHERE TEENS GROW IN STUDYING THEIR HERITAGE IN AN OPEN AND ENRICHING MANNER!

WHO - Boys and Girls AGES 13 - 18

WHEN - MONDAY EVENINGS 6 - 7:45 PM

Insructors: Rabbi Alter Bukiet, Rabbi Avi Bukiet, and Mrs. Luna Zakon-Bukiet 

  

View 2016-17 Hebrew High Calendar

FOR MORE INFO PLEASE CALL AVI AT 617-909-8653 OR EMAIL RABBIAVI@CHABADOFLEXINGTON.COM

Student Information
CHILD 1
Last Name
First Name
Hebrew Name
Gender
Male Female
Date of Birth
School
Medical Information - Any Medical Challenges?
Yes No
If Yes please explain
CHILD 2
Last Name
First Name
Hebrew Name
Gender
Male Female
Date of Birth
School
Medical Information -
Any Medical Challenges?
Yes No
If Yes please explain
CHILD 3
Last Name
First Name
Hebrew Name
Gender
Male Female
Date of Birth
School
Medical Information - Any Medical Challenges?
Yes No
If Yes please explain
Parent Information
Marital Status
Affiliation
 

Father

Title/First Name
Last Name
Work Phone
Cell Phone
Occupation
Email
Mother
Title/First Name
Last Name
Work Phone
Cell Phone
Occupation
Email
Parents
Address
City/State/ Zip
Home Phone
Have there been any conversions or adoptions in the family? Yes No
If yes please explain
Emergency Information
Emergency 1   Emergency 2
Name
  Name
Phone #
  Phone #
Relation
  Relation
Payment Information Due to credit card company fees, Visa will be processed with an additional 2% surcharge and 4% for Master Cards.
Tuition:
$1550.00 per child

Please Choose Payment Method

Card Number
Name on Card
Expiration Date
Security Code
What's This?
Billing Address
Billing Zip
Disclaimer
As the parent(s) or legal guardian of the above child/ren, I/we authorize any adult acting on behalf of Chabad of Lexington to hospitalize or secure treatment for my/our child/ren, I/we further agree to pay all charges for that care and/or treatment. It is understood that if time and circumstances reasonably permit, Chabad of Lexington personnel will try, but are not required, to communicate with me/us prior to such treatment. I/we hereby give permission for my/our child/ren to participate in all school activities, join in class and school trips on and beyond school properties and allow my/our child/ren to be photographed while participating in activities. I/we also understand that all liability and costs resulting from damage to property and/or personal injury caused or attributable to my/our child/children will be my/our responsibility and I/we agree to fully indemnify and save Chabad of Lexington and it’s associates, teachers and agents harmless therefrom. I/we consent to Chabad of Lexington's use of our personal information and of our child/children at its discretion in pursuit of school activities.
Digital Signature

Secure This page uses 128 bit SSL encryption to keep your data secure.

In this Section