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Dedicated to the

Educate your child... educate a generation!

memory of Florence Fondino

ב"ה

Registration

CHABAD FLORENCE FONDINO HEBREW SCHOOL REGISTRATION
Child's Name*

First Name Last Name
Hebrew Name*
Birth Date*

Month Day Year
School*
Previous Jewish Education*
Grade entering*

Address*

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

Additional notable Information
Parents Information
Father's Name*

First Name Last Name
Father Cell

Area Code Phone Number
Father's E-mail
Mother's Name*

First Name Last Name
Mother Cell

Area Code Phone Number
Mother's E-mail
Family History

Is Mother Jewish Is Father Jewish? Any conversions in the family? Any adoptions in the family?
Registration Information
Select Desired Semesters

1st Semester 2nd Semester 3d Semester 4th Semester Full Year
Tuition Fees

$150 for one semester $300 for two semesters $450 for three semesters $500 for full year
Payment Information
Payment Options

Credit Card Please charge my card on file I will mail a check

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

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