Register Online

We are currently accepting application forms for the 2011-2012 school year. Please fill out ALL fields of this form. If you have any questions or concerns you'd like to discuss with us, please contact us.

If you would prefer to fill out this form on paper and mail it to our office, a PDF (which includes registration & tuition agreement) can be found here. 

Please note that one registration form per child is needed.

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

Student Profile
Name
Last
Hebrew Name
DOB	Month Jan. Feb. Mar. Apr. May Jun. Jul. Aug. Sept. Oct. Nov. Dec.     Date 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31    Year 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007
School
Grade Entering	Grade Entering Kindergarten First Second Third Fourth Fifth Sixth Seventh
Hebrew Reading Proficiency	None    Somewhat    Well
Previous Jewish Education	Yes            No
Where?

Parent Information
Father's Name
Father's Occupation
Father's Cell
Mother's Name
Mother's Occupation
Mother's Cell
Home Phone
Address
City
State
Zip
Email Address

Emergency Information
Emergency Contact 1
Phone
Emergency Contact 2
Phone

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!