Hebrew School Registration

Now registering for 2022-2023!

For any questions Contact us at: [email protected] or call us: (201) 886-1238
Student Information

Child 1
How many students are you signing up today?*

If you are signing up 3 or more please contact us
Student Full Name*

First Name Last Name
Hebrew Name*

If student doesn't have one write: none
Date of Birth*

Month Day Year
School Attending*
Grade entering September 2022*
Additional notable Information Please let us know if there are any allergies or other important information we need to be aware of.
Child 2
Student Full Name

First Name Last Name
Hebrew Name

If student doesn't have one write: none
Date of Birth

Month Day Year
School Attending
Grade entering September 2022
Additional notable Information Please let us know if there are any allergies or other important information we need to be aware of.
Parents Information
Marital Status*
Child Lives With*
Is your child's natural mother and maternal grandmother Jewish?*

Yes No
Parent 1
Full name*

First Name Last Name
Birth Date

Month Day Year
Cell Phone*

Area Code Phone Number
E-mail (Please put here your PRIMARY email for all communication)*
Parent 2
Full Name

First Name Last Name
Birth Date

Month Day Year
Cell Phone

Area Code Phone Number
E-mail
Home information

Address*

Home Phone Number

Area Code Phone Number
Have there been any conversions or adoptions in the family?*

Yes No
Primary Mail Correspondence*

Mother Father Both
General Information

Other person authorized to pick up child
Full Name

First Name Last Name
Cell Phone Number

Area Code Phone Number
Relation
Comments
Emergency Information
Emergency Contact 1 Full Name*

First Name Last Name
Cell Phone Number*

Area Code Phone Number
Emergency Contact 2 Full Name

First Name Last Name
Cell Phone Number

Area Code Phone Number
As the parent(s) or legal guardian, 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 attend all field trips and outings sponsored by Chabad Hebrew School. I allow pictures to be taken of my child for school use.*

I agree
I allow my email to be shared with fellow class parents for organizational puposes

I agree
Referred by:

Refer a friend and receive a discount on your family tuition.
Payment Information

PRICE SHOWN IS A LIMITED TIME EARLY BIRD SPECIAL RATE!
Total

$0.00

Payment*

Credit Card Other

Postal / Zip Code

Country

If you are unable to pay please call our office for a scholarship. We will not turn a child away because of a lack of funds.
I would like to receive news and updates by email
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