Student Profile
First Name
Last Name
Hebrew Name
Age
DOB
School
Grade Entering  
 
Parent Information
Father's Name
Father's Cell Number

Mother's Name

 

                                                          

Mother's Cell Number
Home Phone 
Address
City
Zip
Mother's Email*

 

* Email allows us to communicate in the most efficient and economical manner. We do not use your email for other purposes.
 
Emergency Information
Emergency Contact 1
Phone
Relationship
Emergency Contact 2
Phone
Relationship

 

CONFIDENTIAL: Does your child have any allergies or other medical condition we should be aware of? If yes, please describe them and indicate special precautions or care needed.
 
Tuition Agreement

Tuition is 60,000 per semester 


 

Payment Plan

  Full Year 120,000

Which hour will your child be joining?     Wednesday 3:00-4:00     Ages 3-5 

                                                                Wednesday 4:00-5:00    Ages 6-8

 

 Payment
 

Scotia Bank


Account Name: Asociación Lubavitch de Costa Rica

Please make sure to state your childs name and Parsha Story Hour

Cédula Jurídica: 3-002-126820

Dollars: 13000418503 SINIPE 12300130004185039

Colones: 13000418502 SINIPE 12300130004185022
 
 
Terms of Agreement
I agree that in the event of an emergency, Jabad has my permission to arrange for any necessary first-aid or care by a licensed physician/first-aid worker. Jabad has my permission to use my child's photo in its publicity materials. I have completed the Enrollment Form and agree to pay any balance according to the terms of agreement outlined above.
Name
Initials