Registration 2026/27

Check out the Dates and Rates section for tuition and discount rates.
** Please Note - Acceptance to the school is pending director's approval following an interview with Mrs. Alta Goldstein
Parents Information
Mother
Full Name*
First Name Last Name
Hebrew Name
Parent is Jewish

By birthConvertNeither
Cell

Area Code Phone Number
Work Number

Area Code Phone Number
E-mail
Father
Full Name*
First Name Last Name
Hebrew Name
Parent is Jewish

By birthConvertNeither
Cell

Area Code Phone Number
Work Number

Area Code Phone Number
E-mail
Marital Status*
Have there been any adoptions or conversions in the family including grandparents ?*

NoYes
If yes, please explain
I am registering:*

One StudentTwo StudentsThree Students
1. Student Information
Full Name*
First Name Last Name
Hebrew Name
Gender*

MaleFemale
Birth Date*

Month Day Year

Address*

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

School*
Grade entering*
Does your child have any allergies?*

YesNo
If yes, please specify:*
Does your child have any behavioral or learning challenges you would like us to be aware of?*

YesNo
If yes, please specify:*
2. Student Information
Full Name*
First Name Last Name
Hebrew Name
Gender*

MaleFemale
Birth Date

Month Day Year
School*
Grade entering*
Does your child have any allergies?*

YesNo
If yes, please specify:*
Does your child have any behavioral or learning challenges you would like us to be aware of?*

YesNo
If yes, please specify:*
3. Student Information
Full Name*
First Name Last Name
Hebrew Name
Gender*

MaleFemale
Birth Date*

Month Day Year
School*
Grade entering*
Does your child have any allergies?*

YesNo
If yes, please specify:*
Does your child have any behavioral or learning challenges you would like us to be aware of?*

YesNo
If yes, please specify:*
Emergency Information
Physician's Name
Physician's Phone Number
Emergency contact name:
Phone:
Relation:
Parent Volunteer
Our family events are most successful when parents help bring them to life. We invite you to be part of our parent volunteer team by assisting with the planning and coordination of our family programs.
Please check any events you are willing to help with:

Sukkot Family EventChanukah CelebrationPurim CelebrationHebrew School Shabbat Dinner
Payment
You will be charged a $25 registration fee per student.
Would you like your final balance to be charged automatically?

Charge the full amount (Discounts will be applied when applicable)Charge half now and the rest on 12/1Charge MonthlySend invoice and will pay by check
I'm aware that there are students on scholarships. I would like to make a donation towards the scholarship fund .

$50$250$850Other: Please specify amount below.No Thank You
Other scholarship amount:

$
Total

$0.00

Payment

Credit Card

We accept Visa, MasterCard, American Express, Discover
Credit Card Number	Security Code
Name on Card
Expiration Month	Expiration Year

Billing Address

Street Address

City

State / Province

Postal / Zip Code

Country

Agreement:*

As the parent(s) or legal guardian of the above child, I/we authorize any adult acting on behalf of Chabad of Napervillel to hospitalize or secure treatment for my/our child, I/we further agree to pay all charges for that care and/or treatment.
Should be Empty:

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Educate Your Child... Educate a Generation

Parents Information

1. Student Information

2. Student Information

3. Student Information

Emergency Information

Parent Volunteer

Payment