Student Registration 2024-2025

Address:*

Home Phone Number:*

Area Code Phone Number
Father's Name:*
Hebrew Name:*
Cell Phone Number:*

Area Code Phone Number
Mother's Name:*
Hebrew Name:*
Cell Phone Number:*

Area Code Phone Number
Mother's E-mail:
Father's E-mail:
Which email would you like used for updates and newsletters?

Mother'sFather'sBoth
Grandparents Information (for Nachas reports):
We would love to send updates about your child to their grandparents throughout the year.
Paternal Grandparents Full Name:
First Name Last Name

Address:

Address:

E-mail:
Religious & Educational:
Previous Jewish Education:*
Does your child have any learning difficulties with General Studies?*

YesNo
Does your child read basic Hebrew?*

NoneSomewhatWell
If yes, please explain.
Are there any conversions and/or adoptions in the family or grandparents?*

NoYes
If yes, please elaborate.
Medical Information:
Is there any special medical or other information that we should be aware of?**

YesNo
If yes, please describe:
Does your child have any allergies*

YesNo
Emergency Contact #1:*
Is your child currently taking any medication?**

YesNo
Relation:*
Phone Number:*

Area Code Phone Number
Emergency Contact #2:*
Relation:*
Phone Number:*

Area Code Phone Number
Medical Release:*

I hereby give consent to the administration of the Chabad Hebrew School to take whatever medical measures they deem necessary, at my expense, for my child in the event of a medical emergency.
Payment Information
Payment Options:

Pay in full - Complete Year - $850Pay per session - $300Sibling discount - Pay in full -Complete year -$800Thanks to a generous donor, Kindergarten is FREE. $200 Supplies/ Snacks fee.Monthly Ckids Club- $240
Total

$0.00

Payment

Credit Card Check

Postal / Zip Code

Country

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Student Information: