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Chabad Hebrew School

Inspiring Jewish Pride and Identity in Jewish Children - the future of Judaism.

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ב"ה

CHS Registration 2025/26 - Information Form

Family's last name:*
Father/Guardian Information
Name:*
First Name Last Name
E-mail:*
Cell phone:*

Area Code Phone Number
Home phone:

Area Code Phone Number

Home address:*

Street Address
Subdivision
City	State / Province
Postal / Zip Code	Country

Mother/Guardian Information
Name:*
First Name Last Name
E-mail:*
Cell phone:*

Area Code Phone Number
Home phone:(if different)

Area Code Phone Number

Home address: (if different)

Street Address
Subdivision
City	State / Province
Postal / Zip Code	Country

Family Information
Are the child(ren)'s natural parents Jewish by birth?*

YesNo (please explain below)
If no, please explain:
Have there been any conversions or adoptions in your family? (including grandparents)*

Yes (please explain below)No
If yes, please explain:
Medical Information
Physician's name:*
Physician's phone number:*

Area Code Phone Number
Medical Insurer / Health Plan:*
Policy / Group #*
Emergency Contact Information
In case of emergency, if parent or guardian cannot be reached, please contact:
Contact 1 (name, phone & relationship):*
Contact 2 (name, phone & relationship):
Other than parents and emergency contacts, list any people authorized to pick-up students. (name and phone):
Child #1 Information
Name:*
First Name Last Name
Hebrew name:
Birth date:*

Month Day Year
Lives with:*

MotherFatherBoth
Entering grade:*
Knowledge of basic Judaism is:*
Hebrew reading level:*
Any food, medical or insect allergies? If yes, please specify.*
Any physical or learning limitations we should be aware of? If yes, please explain.*
Please list any other information of importance:
Child #2 Information
Name:
First Name Last Name
Hebrew name:
Birth date:

Month Day Year
Lives with:

MotherFatherBoth
Entering grade:
Knowledge of basic Judaism is:
Hebrew reading level:
Any food, medical or insect allergies? If yes, please specify.
Any physical or learning limitations we should be aware of? If yes, please explain.
Please list any other information of importance:
Child #3 Information
Name:
First Name Last Name
Hebrew name:
Birth date:

Month Day Year
Lives with:

MotherFatherBoth
Entering grade:
Knowledge of basic Judaism is:
Hebrew reading level:
Any food, medical or insect allergies? If yes, please specify.
Any physical or learning limitations we should be aware of? If yes, please explain.
Please list any other information of importance:
Enter the message as it's shown*
Should be Empty:

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More in this section

CHS Registration - Parent's Agreement
CHS Registration - Payment 2025

CHS Registration - Scholarship Application

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