Hebrew School Registration

Student Information
Full Name*

First Name Last Name
Hebrew Name

First Name Last Name
Birth Date

Month Day Year

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 Hebrew 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
Is the natural mother of the child Jewish?

Yes No
Is the natural father of the child Jewish?

Yes No
If applicable, please descibe any conversions or adoptions in your family
Accident, Privacy & Field Trip Declaration
Accident: As the parent(s) or legal guardian of [child(ren) listed], I/we authorize any adult acting on behalf of Chabad of Danville & S Ramon 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 personnel will try, but are not required to communicate with me prior to such treatment.

Trips & Outings: I hereby give permission for my child to attend and participate in all trips and outings organized as part of the program.

Privacy: I hereby give permission for my child’s photographs/videos to be used for educational or promotional purposes, which include but are not limited to, brochures, website and social media. I understand that I can withdraw my consent at any time.
Signature of parent or legal guardian:
Date Signed

Month Day Year
Additional Comments
Addditional Comments:
Payment
Full year tuition

$895

Payment

Credit Card Check or Paypal

Postal / Zip Code

Country

E-mail*
I would like to receive news and updates by email
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Club Registration

Student Information

Parents Information

Accident, Privacy & Field Trip Declaration

Payment

Events

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