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Chabad Hebrew School

Inspiring Jewish Pride and Identity in Jewish Children - the future of Judaism.

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New Student Registration

HEBREW SCHOOL REGISTRATION
Number of children being registered:*
CHILD 1
Child's Name*
First Name Last Name
Hebrew Name*
Birth Date*

Month Day Year
School*
Previous Jewish Education*
Grade entering*
CHILD 2
Child's Name
First Name Last Name
Hebrew Name
Birth Date

Month Day Year
School
Previous Jewish Education
Grade entering
CHILD 3
Child Name
First Name Last Name
Hebrew Name
Birth Date

Month Day Year
School
Previous Jewish Education
Grade entering
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

Address*

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

Marital Status
My child/ren is/are
Are the biological mother and the maternal grandmother of the child(ren) Jewish?*

YesNo
If no, please explain:
Have there been any conversions to Judaism in the family?*

YesNo
If yes, please explain:
Have there been any adoptions in the family?*

YesNo
If yes, please explain:
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.
Additional Information you would like to provide:
Emergency Contact
Full Name*
First Name Last Name
Relationship*
Home Number

Area Code Phone Number
Cell Number*

Area Code Phone Number
Work Number

Area Code Phone Number
Payment
Tuition: $500 - full year ($50 sibling discount)Refer a friend and save $50 per family! (Friend must be new to Chabad Hebrew School and will be registering their child for Hebrew School this coming year)

Click here to complete a scholarship request. No child will be turned away due to lack of funds.
Registration:*

Child 1 - $500Sibling - $450Additional Sibling - $450
Total

$0.00

Payment

Credit Card Check

Postal / Zip Code

Country

Referred by:
Comments/Notes:
Should be Empty:

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