Registration Form

We are currently accepting application forms for the 2022-23 school year. Please fill out ALL fields of this form.
If you have any questions, you are welcome to be in touch! | 732-398-9492
Student Information
Student Profile #1:
Full Name

First Name Last Name
Hebrew Name
Birth Date

Month Day Year
Hebrew Reading Proficiency

None Somewhat Well
Previous Jewish Education

Yes No
Where
Is the natural mother of the child Jewish?

Yes No
Have there been any conversions or adoptions in the family? If Yes, please explain.
Student Profile #2:
Full Name

First Name Last Name
Hebrew Name
Birth Date

Month Day Year
Hebrew Reading Proficiency

None Somewhat Well
Previous Jewish Education

Yes No
Where
Is the natural mother of the child Jewish?

Yes No
Have there been any conversions or adoptions in the family? If Yes, please explain.
Student Profile #3:
Full Name

First Name Last Name
Hebrew Name
Birth Date

Month Day Year
Hebrew Reading Proficiency

None Somewhat Well
Previous Jewish Education

Yes No
Where
Is the natural mother of the child Jewish?

Yes No
Have there been any conversions or adoptions in the family? If Yes, please explain.
Parent's Information
Father's Name

First Name Last Name
Phone Number

Area Code Phone Number
Mother's Name

First Name Last Name
Phone Number

Area Code Phone Number

Address

Father's Email Address
Mother's Email Address
Emergency Information
Emergancy Contact #1

First Name Last Name
Phone Number

Area Code Phone Number
Emergancy Contact #2

First Name Last Name
Phone Number

Area Code Phone Number
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.
Agreement |
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*
Payment
Number of Children Registering? Registration/Supplies Fee $150 Per Child
Number of Children Registering? Tuition Fee | $695 Per Child
Total

$0.00

I would like to pay today: Full amount $300.00 minimum $

Credit Card Check

Postal / Zip Code

Country

This page uses TLS encryption to keep your data secure.