Hebrew School Registration

Student Information
We are currently accepting forms for the 2022-2023 school year.

Please fill out ALL fields of this form.

If you have any questions or concerns you'd like to discuss with us feel free to call our director Rochi Galperin at 732-772-1998 or email [email protected]
Student 1 Full Name*

First Name Last Name
Hebrew Name*

First Name Last Name
Birth Date*

Month Day Year
Time of Birth*

Hour Minutes
School*
Grade entering*
Previous Jewish Education
Hebrew Reading Proficiency*

None Somewhat Well
Does your child have any learning disabilities? please specify*
Student 2 Full Name

First Name Last Name
Hebrew Name

First Name Last Name
Birth Date

Month Day Year
Time of birth

Hour Minutes
School
Grade entering
Previous Jewish Education
Hebrew Reading Proficiency

None Somewhat Well
Does your child have any learning disabilities? please specify

Address*

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Additional notable Information Please let us know if there are any allergies or other important information we need to be aware of.
Parents Information
Father's Name*

First Name Last Name
Father's Cell*

Area Code Phone Number
Mother's Name*

First Name Last Name
Mother's Hebrew Name
Mother's Cell*

Area Code Phone Number
Was the child's mother born Jewish?*

Yes No
Is the child's father Jewish?**

Yes No
Was the child's mother's mother born Jewish?*

Yes No
Are there any adoptions in the family?*

Yes No
Are there any conversions in the family?*

Yes No
If you answered yes to either one please specify:
Mother's E-mail*
Father's E-mail*
EMERGENCY INFORMATION
Emergency Contact Besides Parent*

First Name Last Name
Phone Number*

Area Code Phone Number
Pediatrician*

First Name Last Name
Phone Number*

Area Code Phone Number
Medication child is taking on a regular basis*
Any special medical circumstances or allergies*
I authorize Chabad Hebrew School to take my child on school trips. (you will be notified prior to any trips)

I authorize Chabad Hebrew School to take pictures/video of my child and use them for publicity purposes (i.e., Brochures, Websites)

In the event I cannot be reached, I hereby grant permission to the staff of Chabad Hebrew School to treat and/or provide a physician or hospital to give emergency treatment to my child.
*

I have read & agree to all the above.
Signature*
Date*

Month Day Year
Payment
No one will be turned away due to lack of funds; Please contact Rabbi Galperin for payment plans or scholarship requests 732-772-1998.
Payment in Full Upon Submission ($850 per child)

$850 $1700
Two instalments to be be paid upon form submission and Januaray 1, 2023

$425 $850

Payment*

Credit Card Check

Postal / Zip Code

Country

I would like to receive news and updates by email
Should be Empty:

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Photo Gallery

Hebrew School Trip to Jewish Children's Museum

We are proud to announce that Hebrew School registration for the scholastic year of 2021-2022 is now open!

Click here to register

Upcoming Events

There are no events posted at this time. Please contact us for more info about our events.

Jewish tradition has always promoted a loving approach from one individual to another. We are dedicated to making the richness of our Jewish heritage accessible to the contemporary Jew, every Jew, no matter what their level of affiliation of level of religious observance.

Student Information

Parents Information

EMERGENCY INFORMATION

Payment