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 Chabad Hebrew
School
Registration Form
Please submit a separate form for each child you are registering.
About the child
Childs Name:
Hebrew Name:
Birth date:
School Currently Attending:
Does you child read basic Hebrew?
If you chose yes, please rate his or her reading level:
About the child's family
Parent's Name:
Are you, or any family members, affiliated with any other synagogues or Jewish
organizations? If you chose yes, please specify:
Were there any conversions or adoptions in your family?
If you chose yes, please explain:
Is the natural mother of the child Jewish?
In case of an Emergency, who
should we contact:
Name:
Telephone:
Home Information:
Address
Apt.
City State
Zip
Home Phone
Email Address
Additional Comments:
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