General Information -   Secure Online Registration

Child #1   Name:  Hebrew Name: 
Date of Birth:   Grade entering in September:
Choose one option:    Hebrew School     Bar/Bat Mitzvah

Child #2   Name:  Hebrew Name: 
Date of Birth:   Grade entering in September:
Choose one option:    Hebrew School     Bar/Bat Mitzvah

Child #3   Name:  Hebrew Name: 
Date of Birth:   Grade entering in September:
Choose one option:    Hebrew School     Bar/Bat Mitzvah

 
 

Educationial Information
Child #1  Previous Education:
 Does not read Hebrew  Can recognize Hebrew Letters  Reads Slowly


Child #2  Previous Education:

 Does not read Hebrew  Can recognize Hebrew Letters  Reads Slowly

Child #3  Previous Education:
 Does not read Hebrew  Can recognize Hebrew Letters  Reads Slowly

Emergency Contact Information
Name:  Relationship: Phone:

Family Information
Father's Name:   Hebrew Name:
Address:
City:  State:   Zip:
Home Phone:   Cell Phone:
Email:     Occupation:

Mother's Name:   Hebrew Name:
Address:
City:  State:   Zip:
Home Phone:   Cell Phone:
Email:     Occupation:

Paternal Grandparents Name:
Address:  City:  State:  Zip:

Maternal Grandparents Name:
Address:  City:  State:  Zip:
 
Were there any conversions or adoptions in you family? If yes, please explain:
Are the natural parents of the child/ren Jewish? Father  Mother  Both

Medical Information

Is there any special medical or other information regarding your child/ren, of which our school should be made aware?

 Chabad Hebrew School has my permission to arrange for any necessary first aid or care by a licensed physician for my child while he/she is attending school.