Hebrew School Registration 2023-2024

* How many children from your family are you enrolling for the 2023-2024 school year?

* Household Name

* Household Phone Number

* Primary Email Address

* Household Mailing Address

* City

* State

* Zip Code

* Emergency Contact Name

First & Last

* Emergency Contact Relation to Student(s)

* Emergency Contact Phone

Mother/Guardian 1 Information

* First Name

* Last Name

* Email

* Cell Phone

* Is mother Jewish?

Father/Guardian 2 Information

First Name

Last Name

Cell Phone

Is father Jewish?

*Family Information
*We ask these questions in order to better understand and relate to each child.

* Marital Status of Parents

* Any religious conversions or adoptions in the immediate family?

If yes to above, please indicate who is adopted or converted and by which Beit Din:

Did another family or families refer you to our Hebrew School? List their name(s) here if applicable:

Student Information

* Student 1 First Name

* Student 1 Last Name

Hebrew Name

* Date of Birth

* Grade Entering Fall 2023

* School Attending Fall 2023

Please describe any previous Jewish education (if any):

Hebrew reading proficiency:

NoneSomeWell

Food Restrictions/Allergies

Medications

Any medical or special circumstances we should know about to help us best care for our student?

* Student 2 First Name

* Student 2 Last Name

Hebrew Name

* Date of Birth

* Grade Entering Fall 2023

* School Attending Fall 2023

Please describe any previous Jewish education (if any):

Hebrew reading proficiency:

NoneSomeWell

Food Restrictions/Allergies

Medications

Any medical or special circumstances we should know about to help us best care for our student?

* Student 3 First Name

* Student 3 Last Name

Hebrew Name

* Date of Birth

* Grade Entering Fall 2023

* School Attending Fall 2023

Please describe any previous Jewish education (if any):

Hebrew reading proficiency:

NoneSomeWell

Food Restrictions/Allergies

Medications

Any medical or special circumstances we should know about to help us best care for our student?

* Student 4 First Name

* Student 4 Last Name

Hebrew Name

* Date of Birth

* Grade Entering Fall 2023

* School Attending Fall 2023

Please describe any previous Jewish education (if any):

Hebrew reading proficiency:

NoneSomeWell

Food Restrictions/Allergies

Medications

Any medical or special circumstances we should know about to help us best care for our student?

Permission, Release & Waiver of Liability:
By completing this enrollment form and entering my digital signature below, I as the parent or legal guardian of the above child(ren) hereby release Chabad of Lakeview from any and all liability arising from claims for injuries or damages that either individually or on behalf of my child might occur during participation in Chabad Hebrew School activites. I authorize any adult acting on behalf of Chabad of Lakeview's Hebrew School program to treat, hospitalize, or secure treatment for my child. I further agree to pay all charges for that care and/or treatment. It is understood that if time and circumstances reasonably permit, Chabad Hebrew School personnel will try, but are not required, to communicate with me prior to such treatment. I hereby give permission for my child to participate in all school activities. I understand that my child may be photographed while participating in Chabad Hebrew School activities and that these pictures may be used for marketing purposes. By electronically signing my name below, I accept these terms and conditions.

* Electronic Signature:

Enter first & last name

* Date of Signature:

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