Register Online

We are currently accepting application forms for the 2023 - 2024 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 to request a paper copy of the form please contact us.

We look forward to a wonderful year of learning and growth.
Classes begin September 10. Please print a copy of the calendar and keep it handy.

Student Profile
Student #1
First Name
Last Name
Hebrew Name
DOB
School
Grade Entering as of 08/21
Hebrew Reading Proficiency None Somewhat Well
Previous Jewish Education Yes No
Where?
Student #2
First Name
Last Name
Hebrew Name
DOB
School
Grade Entering as of 08/21
Hebrew Reading Proficiency None Somewhat Well
Previous Jewish Education Yes No
Where?
Student #3
First Name
Last Name
Hebrew Name
DOB
School
Grade Entering as of 08/21
Hebrew Reading Proficiency None Somewhat Well
Previous Jewish Education Yes No
Where?
Parent Information
 
Father's Name
Phone
Mother's Name
Phone
Address
City
State
Zip
Home Phone

Email Address
Is Child(ren)'s Father Jewish? Yes No
Is Child(ren)'s Mother Jewish? Yes No
Are there any conversions in the family? Yes No
If YES please explain. Copy and attach conversion documents
Are there any adoptions in the family? Yes No

Medical Information

    Family Physician
    Phone Number
    Hebrew Name
    Does your child have any known allergies Yes
     No
    If yes please specify



    Please check one:

First Taste Program- ages 4-6 Sunday Morning 9:30 AM - 11:30 AM,   Fee: $400

Hebrew School- Grades 1-6 Sunday Morning 9:30 AM- 12:00 PM  Fee: $425

Hebrew School- Grades 7-8 Sunday Morning 9:30 AM- 12:00 PM  Fee  $425

Bat Mitzvah Club- Learn what it means to become a bat mitzvah. This will include crafts, games and activites, to prepare your daughter for this milestone in a fun and fulfilling way!- Details coming soon

C-Teens- High School Monthly - Call for additional information

Total Payment Due Submitted via

Payment can be mailed in to the office 2285 St Andrews Cir. Bettendorf, IA 52722or brought in prior to the first day of Hebrew School, as long as the registration is submitted prior to that.
Limited scholarships are available, arrangements must be made with our office for special considerations.


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.


As the parent(s) or legal guardian of the above child, I/we authorize any adult acting on behalf of Chabad Hebrew School to hospitalize or secure treatment for my child, I further agree to pay all charges for that care and/or treatment. It is understood that if time and circumstances reasonably permit, Chabad Hebrew School personnel will try, but are not required, to communicate with me prior to such treatment. I hereby give permission for my child to participate in all school activities, join in class and school trips on and beyond school properties and allow my child to be photographed while participating in Chabad Hebrew School activities and that these pictures may be used for marketing purposes.

I Accept

Name: Initials:

We look forward to a wonderful year of learning and growth!