Please fill out all fields in this form. If you have any questions or concerns you’d like to discuss with us, please call us at 818-802-8555.

Please note that one registration form per child is needed.

Important: A signed Risk Waiver Form is required with each registration. 

Student Profile
 
First Name
Last Name
Hebrew Name
DOB
Gender Male     Female
School Attending
Current Grade
Hebrew Reading Proficiency None Somewhat Good
Is the biological mother of this child Jewish? Yes No
Have there been any conversions or adoptions in the maternal family history? Yes No
If Yes, please explain:

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. 

Parent Information
 
Father's Name
Phone
Email
Mother's Name
Phone
Email
Address
City
State
Zip
Home Phone
Emergency Information (in addition to parents)
 
Emergency Contact
Relationship to child
Phone

 

Payment Information

 

Name on card First  Last 
Credit Card Number
Expiration Date
CVV
Billing Address
Billing Zip
Payment amount $

 

Once our office receives this form, an appointment will be set up with our staff, who will then determine the eligibility of each student.

I/we allow Chabad Hebrew School permission to take my/our child/ren on outings and allow them to give emergency medical care as necessary.

I Accept

Name: Initials:

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