We are currently accepting application forms for the 2018-2019 school year. Please fill out ALL fields of this form. If you have any questions or concerns you'd like to discuss with us, or would like to request a printable registration form please   contact us .

Please note that one registration form per child is needed.

We looK forward to a wonderful year of learning and growth.



Student Information

Family Name Child's First Name

Hebrew Name

Gender Male Female
Date of Birth    

Does your child speak/understand Hebrew?

None Somewhat Well
Does your child have previous Jewish education? Yes No
If Yes please describe
What school does your child attend?  

Has your child ever had a psychological assessment?
Yes No

Does your child have any food allergies or special needs we should know to better accomodate him/her in thew class?

Yes No


If yes, date:
Is there anything else we should know about your child?
Synagogue affiliated with  
Have there been any conversions or adoptions in the family, if yes please explain?(For Conversions, please type in the Rabbi's name)
Please name other children that you are registering:  
Name Age & Date of Birth
Name Age & Date of Birth
Please place my child with the following friends

Parent Information

Father's Name Home Phone
Work Phone Email adress (home)
Cell Occupation
Home Address Home City
Home Province Home Postal Code
Marital Status Married Separated Divorced
  If divorced Stepfather how long
    Stepmother how long
Mother's Name Home Phone
Work Phone Email Adress (home)
Cell Occupation
Home Address(If different then above) Home City
Home Province Home Postal Code

Emergency Contact Information

Plese list two contact to be used in case of emergencies  
Name 1 Relationship to child
Home Phone Cell
Name 2 Relationship to child
Home Phone Cell




Does your child have any allergies, other medical conditions or special needs we should be aware of?
Yes No If yes, please describe them and indicate special precautions or care needed.

As the parent(s) or legal guardian of the above child, I/we authorize any adult acting on behalf of Chabad of Camarillo Hebrew School to hospitalize or secure treatment for my/our child, 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 Camarillo Hebrew School 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 to participate in all school activities, join in class and school trips on and beyond school properties and allow my/our child to be photographed while participating in Hebrew School 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 Hebrew School and it’s associates, teachers and agents harmless therefrom. I/we consent to Chabad of Camarillo Hebrew School’s use of our personal information and of our child/children at its discretion in pursuit of school activities.

Date Initial

Tuition Fees

Click box Day   Tuition



Monday's 4:15-5:15pm    



Full amount is due by December 31, 2018 (Can be paid in two $180 payments)


Payment Methods


You may choose from the following payment methods:

The tuition can be paid in full when registering your child.

Alternatively, it could be broken up into two equal payments, but only with checks.
  • 1st payment is upon registration.
  • 2nd payment is due by December 31, 2018.
  • Head-checks dated for each of these dates are due at registration.
  • Please make all checks payable to Chabad of Camarillo and submit them together with the registration form.
  • There are no refunds or credits for days missed due to illness, holidays, or family vacations.
  • Charitable tax receipts will be issued for the full amount of all tuition fees paid.

Billing Information

I would like to assist a child who cannot afford Hebrew School Education.
Cash Check (Applications will be processed upon receiving of payment)
Credit Card    
Name on card    
Card # Expiry
CVV security code #

I heard about the Chabad of Camarillo Hebrew School from: