Printed from

Hebrew School Registration

Hebrew School Registration


Student's Name:

Hebrew Name:

Birth Date:  /    /      /

Telephone # Cell Phone:


School Name & City:

Mothers Name Mothers Hebrew Name:

Fathers Name Fathers Hebrew Name:

Is the natural mother of the child Jewish?______

Are there any conversions or adoptions in the family history? *

* These questions enable us to better serve our constituents. All information will remain confidential.


Describe Basic Hebrew Knowledge: (previous Hebrew School education, Hebrew reading, holidays)

Does your child have any learning difficulties with general studies?


Is there anything you want us to know about our child that would help us to help him/her?

Synagogue Affiliation:


Would you be willing to help with school activities? yes/no

Does either parent have any special resources or skills to offer our children or teachers?


The following are authorized to take my child to and from school:

Name phone:

There is a $50.00 registration & book fee that is non-refundable.

Tuition is $450.00 plus registration fee of $50**

** We will NEVER turn away a Child for lack of funds. If you require a Scholarship, please call or Email our office.

Complete registration form and submit with deposit.

Mail to : Hebrew School c/o Chana Lew 7227 W Bluefield Ave, Glendale, AZ 85308




In case of emergency, when neither parent can be reached,


permission is given to the school staff to phone child’s doctor:

Doctor Phone

Address City

Hospital Affiliation

If parents cannot be reached and emergency medical advice is needed,


authorize the paramedics to take my child to the nearest hospital


In case of medical emergency requiring immediate emergency care, I



Allergy reactions to medications

Medication child is taking on a regular basis

Any special medical allergy or condition

Parent’s signature Date

Registration Form Medical Information


New Programs I am Interested In:

Hebrew School for Parents

Family Workshop Coordination

Wednesday Night Hebrew

Special Events Volunteer


give names of two people who will take responsibility for your child.

Name Name

Phone Phone

Address Address

City City

Relationship to child Relationship to child


Become a partner in our vital work

Daily Study

Visit daily with our Daily Study portal

Web ad for Chabad, Dr. C 300x250.jpg