Please fill out this form as an initial registration for Hebrew School
Confirmation of acceptance will be acknowledged after this registration form is reviewed.
Student Information
Full Name:
Birthday: Gender:
Family Information
Home Address:
Home Phone Number:
Father:
Mother:
Which email would you like used for updates and newsletters? Mother Father Both
Religious & Educational:
What school does your child attend? Grade entering:
Does your child have previous Jewish Education Yes No
If yes, please describe:
Does your child read basic Hebrew? None Somewhat Well
Does your child speak/understand Hebrew? None Somewhat Well
Any considerations, such as learning disorder or difficulty, the school should be aware of? (Confidential):
Is the natural mother of the child Jewish? Yes No
Is the natural grandmother of the child Jewish? Yes No
Were there any conversions or adoptions in your family? Yes No
If yes, please describe:
Medical & Emergency Information
Is there any special medical or other information that we should be aware of? Yes No
If yes, please describe:
Does your child have any allergies? Yes No
If yes, please describe:
Is your child currently taking any medication? Yes No
If yes, please describe:
Emergency Contact #1:
Emergency Contact #2:
I hereby give consent to the administration of the Chabad Hebrew School of the Arts to take whatever medical measures they deem necessary, at my expense, for my child in the event of a medical emergency.
I hereby give permission to my child to participate in all school outings and field trips beyond school properties and to use any transportation selected by the Chabad Hebrew School.
I give permission to use pictures of my children in public settings like Chabad's website, and advertising and marketing materials
