Child Information 
 Child 1 Child 2
 Name: (first, last)
 Name: (first, last)
Hebrew Name

Hebrew Name
     

Nickname
 

Nickname
 
DOB (MM/DD/YY) DOB (MM/DD/YY)
School grade (as of Aug 2011) School grade (as of Aug 2011)
Name of school attending Name of school attending

Does your child    
read basic Hebrew?
Well    Fair   Not at all    

Does your child
read basic Hebrew?
Well   Fair Not at all   

Does your child speak Hebrew?

Well    Fair  Not at all

Does your child speak Hebrew?

Well  FairNot at all        

Your child's favorite subjects

Your child's favorite subjects
 

Your child's favorite activities

Your child's favorite activities
 

How would you describe your child to others?

How would you describe your child to others?
 

Do your child/children have any previous Jewish Education? Please describe:

What would you like your child/children to gain by joining Chabad Hebrew School?: 
     

 
Parents Information
Father's Information Mother's Information
(skip fields if same as Father)
Born Jewish  Not Jewish   
Converted to Judaism
Born Jewish  Not Jewish
  Converted to Judaism
Name
Name
Hebrew Name
Hebrew Name
Occupation

Occupation
     

Address
Address
City
City
State    Zip State   Zip
Home Phone
Home Phone
Work Phone
Work Phone
Cell Phone
Cell Phone
Email Address
Email Address
   
Medical/Health Information
Is there any special medical or any other information regarding your child/children that our school should be aware of?
Is your child/children allergic to any foods? If yes please explain in detail
 
Emergency Contact Information (if a parent cannot be reached)
Name:    Phone: 
Name:    Phone:
Doctor's Name  Phone:  
 
 
 
 
Parent Name   Date