Student Profile
Student Name
Hebrew Name (Optional)
DOB
School
Grade Entering
Hebrew Reading Proficiency
None
Somewhat
Well
Previous Jewish Education
Yes
No
Where?
Father Information
Father's Name
Phone
Address
Email Address
Jewish
By Birth
By Choice
Mother Information
Mother's Name
Phone
Address
Email
Jewish
By Birth
By Choice
Maternal Grandmother
Jewish By Birth
Jewish By Choice
Emergency Contact Information
Emergency Contact 1
Phone
Emergency Contact 2
Phone
Doctor
Address
Phone
CONFIDENTIAL: Does your child have any allergies, food restrictions or other medical condition we should be aware of? If yes, please describe them and indicate special precautions or care needed. Is there anything else that you think would be helpful for us to know about your child?
Payment Information - 2025/26
We would like to apply for:
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.
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