Hebrew School Registration

Hebrew School Registration
Family Name*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Primary Phone Number*

Area CodePhone Number
Father's Name*

First NameLast Name
Father's Hebrew Name (if available)
Address (if different)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Father's Email*
example@example.com
Father's Cell Number:*

Area CodePhone Number
Mother's Name*

First NameLast Name
Mother's Hebrew Name (if available)
Address (if different)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Mother's Email*
example@example.com
Mother's Cell Number*

Area CodePhone Number
Marital Status of Parents:*
Does someone other than the parent(s) care for your child(ren)?
If yes, please provide their name
Phone Number

Area CodePhone Number
Is the Birth Mother of the Child Jewish?*

yesno
Is the Mother's Mother Jewish?*

yesno
Is the Birth Father of the Child Jewish?*

yesno
Is the Father's Mother Jewish?*

yesno
Are there any adoptions/conversions in the family history? Please explain*
Child Information
Child's Name*

First NameLast Name
Child's Hebrew Name (if available)
Date of Birth

MonthDayYear
Date
Hebrew Date of Birth (if not known, please indicate time of birth)
Grade Entering:*
Placement in Family*
Please name and age siblings of student who are not being enrolled in the Hebrew School year of 2018-19

Confidential
Does your child have any allergies, other medical conditions or special needs we need to be aware of?*

YesNo
If yes, please describe them and indicate special precautions or care needed:
Does your child have any allergies, other medical conditions or special needs we need to be aware of?*

YesNo
If yes, please describe them and indicate special precautions or care needed:
Please indicate which child the above information applies to

School Policies
DISPOSITION
Parent acknowledges that the CHS serves children who are able to function successfully in a group setting. If, in the judgment of the school's Director, the child is not able to function in a group setting, the parent may be asked to withdraw the child. In the event that the parent is requested to withdraw the child, the Director will work with the parent to identify possible alternative programs suitable for the child.

LEAVING SCHOOL BUILDING
For off-site trips, parent will be notified in advance and asked to sign permission slips.

SCHOOL CLOSINGS
Every effort is made to remain open on all regularly scheduled days. However, if we are forced to be closed or to have a delayed opening, parents will be telephoned and/or e-mailed by 8am. If parent does not answer phone, a message will be left on the answering machine.
Release of Information and Photographs

I give permission for my child(ren)'s photograph/name to be released to newspapersI give permission for my child(ren)'s picture to be used for internal PR mailing and website where name is not given.
School Directory

I want my child(ren)'s information included in the school directory.
By submitting and initialing this form, parents accept the terms outlined above.
Initials*
Date*

MonthDayYear
Date
Should be Empty:

Child Information