REGISTER

REGISTRATION FORM
We are currently accepting application forms for the coming school year. Please fill out ALL fields of this form. If you have any questions or concerns you'd like to discuss with us, please contact us.
For more info, call our office at (508) 473-1299 or email [email protected].
Please note that you need to fill out a separate registration form for each child.
Once the completed form is received, please allow up to 7 business days to receive a reply and/or acceptance letter.
Child would like to attend:*

Hebrew School
Child's Name*
First Name Last Name
Hebrew Name*
If you're not sure, write "not sure"
Birth Date*

Month Day Year
School*
Grade entering*
Previous Jewish Education*
If any.
Hebrew reading proficiency*

NoneSomewhatWell

Address*

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Does your child have a medical condition or allergy, we should be aware of? (CONFIDENTIAL):*

YesNo
If yes, please describe it/them, & indicate what, if any, special precautions or care are needed. (CONFIDENTIAL)
Only personnel that are required to know will be notified.
Additional notable Information
Parents Information
Father's Name*
First Name Last Name
Father Cell*

Area Code Phone Number
Father's Hebrew Name
If unknown or doesn't have one, please let us know.
Father's email address:*
Mother's Name*
First Name Last Name
Mother Cell*

Area Code Phone Number
Mother's Hebrew Name*
If unknown or doesn't have one, please let us know.
Mother's email address:*
Parents are:*

MarriedDivorcedSeperatedIt's complicated!
Were both parents born to Jewish parents?*

YesNo
If not, please explain:
Were there any conversions or adoptions in the family?*

YesNo
If yes, please explain:
By clicking the "Submit Button" below:
I hereby permit my child/ren to participate in all school activities, on and off campus, and to join in class and school trips on and beyond school properties and use any transportation selected by the Chabad staff. I will not hold Chabad or any of its officers and/or volunteers responsible.
I allow Chabad and its staff to photograph and post photos of my child/ren for promotional or other purposes, in print and online.
I hereby give my consent to the administration of the Chabad Center to take whatever medical measures they deem necessary, at my expense, for my child, in the event of a medical emergency. I will not hold them responsible for their decisions.
By typing my initials here, I consent to all of the above:*
Write your initials in this box.
Payment
* The remainder of tuition can be paid now (below) or no later than July 30.

_______________________
* We're aware that some people are having financial difficulties. At Chabad we have the real "NO CHILD WILL BE LEFT BEHIND" program. Partial scholarships may be available for parents who can't afford the full tuition cost. Please reach out to us so we can help you.
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Postal / Zip Code

Country

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Educate Your Child... Educate a Generation

REGISTRATION FORM

Parents Information

Payment