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Cell Phone*

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Father's Name*
First Name Last Name
Father's Hebrew Name
Cell Number

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Occupation
Were there any conversions or adoption in your family? Grandparents, parents, or child?*

YesNo
Conversion / Adoption Details
Are the natural parents of the child/ren Jewish?*

Both are JewishMother is JewishFather is Jewish
Is there any special medical or other information regarding your child/ren, of which our school should be made aware?
As the parent(s) or legal guardian of the above child, I/we authorize any adult acting on behalf of Chabad Hebrew School to 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, join in class and school trips on and beyond school properties and allow my child to be photographed while participating in Chabad Hebrew School activities and that these pictures may be used for marketing purposes.
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