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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

First-time Student Registration

Student Information:
Full Name*
First Name Last Name
Hebrew Name: *
Gender: *
Grade entering in September:*
Birth Date*

Month Day Year
Time of Day:* To calculate Jewish Birth date
Hour Minutes
School Currently Attending:*
Family Information:
If filling out for 2nd or 3rd child

All family information is the same as the first child.

Address*

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

Home Phone Number: *

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

Area Code Phone Number
Father's Cell Phone Number:*

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

Area Code Phone Number
Mother's Cell Phone Number:*

Area Code Phone Number
Mother's Occupation:*
Mother's E-mail:*
Father's E-mail:*
To Which email and cell number (WhatsApp) 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:
Cell Phone Number For WhatsApp updates

Area Code Phone Number
Maternal Grandparents Full Name:
First Name Last Name

Address:

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

E-mail:
Cell Phone Number For WhatsApp updates

Area Code Phone Number
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.
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
If Yes, please describe*
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
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 of the Arts 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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Chabad of East County

7189 Navajo Road Suite B S. Diego, CA 92119

619-387-8770

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