New Student Registration

If you prefer, you can print a PDF form by CLICKING HERE.

Full Name*

First Name Last Name

Hebrew Name: *

Gender: *

Grade entering in September:*

Birth Date*

Month Day Year

Time of Day:*

Hour Minutes

School Currently Attending:*

I would like my child to join:

In person (following CDC guidelines)Virtual TrackA Pod

All family information is the same as the first child.

Address*

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

Home Phone Number: *

Area Code Phone Number

Father's Name:*

Hebrew Name:*

Work Phone Number:

Area Code Phone Number

Cell Phone Number:

Area Code Phone Number

Father's Occupation:*

Mother's Name: *

Hebrew Name:*

Work Phone Number:*

Area Code Phone Number

Cell Phone Number:*

Area Code Phone Number

Mother's Occupation:*

Mother's E-mail:*

Father's E-mail:*

Which email would you like used for updates and newsletters?*

Mother'sFather'sBoth

Marital Status:*

MarriedSingleDivorced

Paternal Grandparents Full Name:

First Name Last Name

Address:

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

E-mail:

Maternal Grandparents Full Name:

First Name Last Name

Address:

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

E-mail:

Previous Jewish Education:*

Does your child read basic Hebrew?*

NoneSomewhatWell

Does your child have any learning difficulties with General Studies?*

YesNo

If yes, please describe:

Does your child have an IEP?*

YesNo

*If yes, please submit a copy with the registration form.

Is the natural mother of the child Jewish?*

YesNo

Is the natural father of the child Jewish?*

YesNo

Is the maternal grandmother of the child Jewish?*

YesNo

Are there any conversions and/or adoptions in the family?*

YesNo

Is there any special medical or other information that we should be aware of?*

YesNo

If yes, please describe:

Does your child have any allergies?*

YesNo

Is your child currently taking any medication?*

YesNo

Emergency Contact #1:*

Relation: *

Phone Number:*

Area Code Phone Number

Emergency Contact #2:*

Relation: *

Phone Number:*

Area Code Phone Number

Medical Release:*

I hereby give consent to the administration of the Chabad Hebrew School of the Arts to take whatever medical measures they deem necessary, at my expense, for my child in the event of a medical emergency.

Permission Slips:*

I hereby give permission to my child to participate in all school outings and field trips beyond school properties and to use any transportation selected by the Chabad Hebrew School.

How did you hear about Chabad Hebrew School of the Arts?

By clicking submit, I grant permission for my child to be photographed in individual or group pictures which may be used by Chabad Hebrew School for P.R.

Student Information:

Family Information:

Grandparents Information (for Nachas reports):

Religious & Educational:

Medical Information:

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