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Hebrew School of the Arts

Inspiring Jewish Pride and Identity in Jewish Children - the future of Judaism.

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ב"ה

Returning Student Registration Form

Student Information:
Full Name*
First Name Last Name
Grade entering in September:*
School Currently Attending:*
E-mail to receive copy of this form*
Family Information:
All information from last year is current.
Please scroll down and fill out the fields with red asterisk.

Address

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

Home Phone Number:

Area Code Phone Number
Father's Name:
Hebrew Name:
Work Phone Number:

Area Code Phone Number
Cell Phone Number:

Area Code Phone Number
Father's Occupation:
Mother's Name:
Hebrew Name:
Work Phone Number:

Area Code Phone Number
Cell Phone Number:

Area Code Phone Number
Mother's Occupation:
Mother's E-mail:
Father's E-mail:
Which email would you like used for updates and newsletters?

Mother'sFather'sBoth
Marital Status:

MarriedSingleDivorced
Grandparents Information (for Nachas reports):
We would love to send updates about your child to their grandparents throughout the year.
Paternal Grandparents Full Name:
First Name Last Name

Address:

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

E-mail:
Maternal Grandparents Full Name:
First Name Last Name

Address:

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

E-mail:
Religious & Educational:
Previous Jewish Education:
Does your child read basic Hebrew?

NoneSomewhatWell
Does your child have any learning difficulties with General Studies?*

YesNo
If yes, please describe:
Does your child have an IEP?*

YesNo
*If yes, please submit a copy with the registration form to [email protected].
Is the natural mother of the child Jewish?

YesNo
Is the natural father of the child Jewish?

YesNo
Is the maternal grandmother of the child Jewish?

YesNo
Are there any conversions and/or adoptions in the family?

YesNo
Medical Information:
Is there any special medical or other information that we should be aware of?*

YesNo
If yes, please describe:*
Does your child have any allergies?*

YesNo
If yes, please describe:*
Is your child currently taking any medication?*

YesNo
Emergency Contact #1:
Relation:
Phone Number:

Area Code Phone Number
Emergency Contact #2:
Relation:
Phone Number:

Area Code Phone Number
Medical Release:*

I hereby give consent to the administration of the Chabad Hebrew School to take whatever medical measures they deem necessary, at my expense, for my child in the event of a medical emergency.
Permission Slips:*

I hereby give permission to my child to participate in all school outings and field trips beyond school properties and to use any transportation selected by the Chabad Hebrew School.
How did you hear about Chabad Hebrew School of the Arts?
By clicking submit, I grant permission for my child to be photographed in individual or group pictures which may be used by Chabad Hebrew School for P.R.
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7189 Navajo Road Suite B S. Diego, CA 92119

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