Hebrew School Registration

Student Information
We are currently accepting forms for the 2026-2027 school year.

FIRST DAY OF HEBREW SCHOOL IS SUNDAY, SEPTEMBER 6TH 2026

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 *

NoneSomewhatWell
Does your child have any learning disabilities? please specify *
Does your child recieve behavorial support in his/her regular school*
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

NoneSomewhatWell
Does your child have any learning disabilities? please specify
Does your child recieve behavorial support in his/her regular school*

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?*

YesNo
Is the child's father Jewish?**

YesNo
Was the child's mother's mother born Jewish?*

YesNo
Are there any adoptions in the family?*

YesNo
Are there any conversions in the family?*

YesNo
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 ($1000 per child)

$1000$2000
Two instalments to be be paid upon form submission and January 1, 2027

$500$1000
Total

$0.00

Payment*

Credit Card Check

Postal / Zip Code

Country

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Student Information

Parents Information

EMERGENCY INFORMATION

Payment