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Hebrew School Registration Form

Hebrew School Registration Form

Secure Online Registration

Student Information
First Name Last Name
Hebrew Name D.O.B.
School Grade Entering
Hebrew Reading Proficiency None Somewhat Well
Previous Jewish Education Yes No
If yes - where?

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 due whatever is necessary to attend to my child in the case of an emergency medical situation while attending school.
Fees

Registration Fees per child $50.00

Book Fees per child $40.00

Tuition Fees per child $500.00 per year (payable over 12 months)

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