Hebrew School Registration

Hebrew School Registration

B"H
Welcome to Hebrew School
Childs Name

First NameLast Name
Hebrew name
Grade
School currently attending
Mothers Name

First NameLast Name
Mothers Email
example@example.com
Mothers cell
Fathers Name

First NameLast Name
Fathers Email
example@example.com
Fathers cell
Synagogue affiliated with
Is child's biological mother Jewish?
Any previous Jewish education?
If yes please explain
Any conversions or adoptions in the family?
If yes please explain
Does your child have any learning disabilities or disorder? (confidential)

Does the child live with both parents?
If not please describe situation
Childs Primary Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Secondary address if necessary

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Emergency Contact 1
Relationship to the child
Phone
Format: (000) 000-0000.
Emergency Contact 2
Relationship to the child
Phone
Format: (000) 000-0000.
Does your child have any allergies or other medical conditions we should be aware of?
If yes please explain and indicate any precautions or care needed
OPTIONAL

Bar/Bat Mitzvah Information (For Students in Grades 3-7)
Bar and Bat Mitzvah celebration dates are reserved on a first come, first serve basis.

Please indicate your date preference and we will notify you of availability.
Childs Hebrew Birthday
BAR/BAT MITZVAH
First Preference
Second Preference
Third Preference

Parental Consent Form
1) I agree to follow all policies stated in the Lubavitch Hebrew School Parent Handbook and understand my responsibilities as a school parent.

2) I allow my child to attend all field trips taking place throughout the year.

3) I hereby grant permission for photography and videography of my child's activities at the Hebrew School or any activities related to Hebrew School care for public relations purposes. I agree that I am to receive no compensation for my child's appearance and that this participation confers on me no ownership rights

4) I give permission to Lubavitch Hebrew School in the event of a medical emergency to seek and administer medical attention for my child and if necessary, to hospitalize him/her.

5) In the event that I cannot come to Lubavitch Hebrew School to pick up my child, I hereby authorize the following people to pick up my child from school. I understand that only those individuals listed by me below will be given permission to pick up my child.
Name
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Name
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Parents Initials
Parents Signature

Payment

A deposit of $250 is required for all Hebrew School students. Once your registration has been completed, you will be directed to an Online Payment form. Please complete the Online Payment form and click "Submit".

To open the Online Payment form you may also click HERE

Hebrew School Deposit

$250.00 Quantity
Item subtotal:

Total

Credit Card

First Name

Last Name

Credit Card Number

Security Code

Expiration Month

Expiration Year

Billing Address

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Country

Should be Empty: