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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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