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Parent and Family Info Adult 1: Name* First Name Last Name Adult 1: Phone Number* Area Code Phone Number Adult 1: E-mail* Address* Street Address Street Address Line 2 City State / Province Postal / Zip CodePlease SelectUnited StatesAfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanThe BahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChilePeople's Republic of ChinaRepublic of ChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongoCook IslandsCosta RicaCote d'IvoireCroatiaCubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonThe GambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorthern MarianaNorwayOmanPakistanPalauPanamaPapua New GuineaParaguayPeruPhilippinesPitcairn IslandsPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint BarthelemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSomalilandSouth AfricaSouth OssetiaSpainSri LankaSudanSurinameSvalbardSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTristan da CunhaTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamBritish Virgin IslandsUS Virgin IslandsWallis and FutunaWestern SaharaYemenZambiaZimbabweOther Country Adult 2: Name First Name Last Name Adult 2: Phone Number Area Code Phone Number Adult 2: E-mail Adult 2: Address, if different from above Street Address Street Address Line 2 City State / Province Postal / Zip CodePlease SelectUnited StatesAfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanThe BahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChilePeople's Republic of ChinaRepublic of ChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongoCook IslandsCosta RicaCote d'IvoireCroatiaCubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonThe GambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorthern MarianaNorwayOmanPakistanPalauPanamaPapua New GuineaParaguayPeruPhilippinesPitcairn IslandsPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint BarthelemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSomalilandSouth AfricaSouth OssetiaSpainSri LankaSudanSurinameSvalbardSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTristan da CunhaTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamBritish Virgin IslandsUS Virgin IslandsWallis and FutunaWestern SaharaYemenZambiaZimbabweOther Country Emergency Contact Name* First Name Last Name Emergency Contact Cell Phone Number* Area Code Phone Number Emergency Contact Second Phone Number Area Code Phone Number Physicians Name* First Name Last Name Physicians Phone Number* Area Code Phone Number Is your child(ren)'s Father Jewish?* YesNo Is your child(ren)'s Mother Jewish?* YesNo Are there any conversions in the family?* NoYes Please explain: Are there any adoptions in the family?* NoYes Please explain: Student's Info - Child 1 Child 1: Name* First Name Last Name Child 1: Hebrew Name* Chid 1: Birth Date* 20262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920 Year1 - January2 - February3 - March4 - April5 - May6 - June7 - July8 - August9 - September10 - October11 - November12 - December Month12345678910111213141516171819202122232425262728293031 Day Child 1: Time of Birth* 123456789101112 Hour001020304050 MinutesAMPM Child 1: Grade* (Entering into the 2025/2026 school year) Kindergarten1st2nd3rd4th5th6th7th Child 1: Does your child attend any special education program in public school?* If yes, please explain. Child 1: Does your child have any special abilities or disabilities?* If yes, please explain. Child 1: Is your child on any special medication that the school should be aware of?* If yes, please specify. Child 1: If new to Chabad, Please tell us about your child's previous education.* Previous School/Synagogue, City, Number of years, Days per week, Hebrew learning experience. Please enter your promo code (if applicable): Child 1: Program Selection.* "First Taste" Program (grades K, 1) - Sunday, 9:30am - 12:00pm - $1050My child is a Blue Room graduate who is entering the Kindergarten Hebrew School Class - $525Hebrew School (grades 2 - 7) - Sunday, 9:30am - 12:00pm, Wednesday 4:30 - 6:00pm - $1400 Child 1: Program Selection (Jewish Day School Student discount applied)* "First Taste" Program (grades K, 1) - Sunday, 9:30am - 12:00pm - $500My child is a Blue Room graduate who is entering the Kindergarten Hebrew School Class - $525Hebrew School (grades 2 - 7) - Sunday, 9:30am - 12:00pm, Wednesday 4:30 - 6:00pm - $675 Child 1: T-Shirt Size * Add another child. Student's Info - Child 2 Child 2: Name* First Name Last Name Child 2: Hebrew Name* Chid 2: Birth Date 1 - January2 - February3 - March4 - April5 - May6 - June7 - July8 - August9 - September10 - October11 - November12 - December Month12345678910111213141516171819202122232425262728293031 Day20262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920 Year Child 2: Time of Birth* 123456789101112 Hour001020304050 MinutesAMPM Child 2: Grade (Entering into the 2025/2026 school year) Kindergarten1st2nd3rd4th5th6th7th Child 2: Does your child attend any special education program in public school? If yes, please explain. Child 2: Does your child have any special abilities or disabilities? If yes, please explain. Child 2: Is your child on any special medication that the school should be aware of? If yes, please specify. Child 2: If new to Chabad, Please tell us about your child's previous education. Previous School/Synagogue, City, Number of years, Days per week, Hebrew learning experience. I have a promo code:* YesNo Please enter your promo code:* Child 2: Program Selection.* "First Taste" Program (grades K, 1) - Sunday, 9:30am - 12:00pm - $1050My child is a Blue Room graduate who is entering the Kindergarten Hebrew School Class - $525Hebrew School (grades 2 - 7) - Sunday, 9:30am - 12:00pm, Wednesday 4:30 - 6:00pm - $1400 Child 2: Program Selection (Jewish Day School Student discount applied* "First Taste" Program (grades K, 1) - Sunday, 9:30am - 12:00pm - $500My child is a Blue Room graduate who is entering the Kindergarten Hebrew School Class - $525Hebrew School (grades 2 - 7) - Sunday, 9:30am - 12:00pm, Wednesday 4:30 - 6:00pm - $675 Child 2: T-Shirt Size* Add another child. Student's Info - Child 3 Child 3: Name* First Name Last Name Child 3: Hebrew Name* Chid 3: Birth Date* 1 - January2 - February3 - March4 - April5 - May6 - June7 - July8 - August9 - September10 - October11 - November12 - December Month12345678910111213141516171819202122232425262728293031 Day20262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920 Year Child 3: Time of Birth* 123456789101112 Hour001020304050 MinutesAMPM Child 3: Grade (Entering into the 2025/2026 school year) Kindergarten1st2nd3rd4th5th6th7th Child 3: Does your child attend any special education program in public school? If yes, please explain. Child 3: Does your child have any special abilities or disabilities? If yes, please explain. Child 3: Is your child on any special medication that the school should be aware of? If yes, please specify. Child 3: If new to Chabad, Please tell us about your child's previous education. Previous School/Synagogue, City, Number of years, Days per week, Hebrew learning experience. I have a promo code:* YesNo Please enter your promo code:* Child 3: Program Selection.* "First Taste" Program (grades K, 1) - Sunday, 9:30am - 12:00pm - $1050My child is a Blue Room graduate who is entering the Kindergarten Hebrew School Class - $525Hebrew School (grades 2 - 7) - Sunday, 9:30am - 12:00pm, Wednesday 4:30 - 6:00pm - $1400 Child 3: Program Selection (Jewish Day School Student discount applied* "First Taste" Program (grades K, 1) - Sunday, 9:30am - 12:00pm - $500My child is a Blue Room graduate who is entering the Kindergarten Hebrew School Class - $525Hebrew School (grades 2 - 7) - Sunday, 9:30am - 12:00pm, Wednesday 4:30 - 6:00pm - $675 Child 3: T-Shirt Size* Payment InfoAdditional Fees:$50 Registration Fee, per family$220 Security Fee, per family Security FeeRegistration Fee I would like to pay:* Full amount todayMonthly payments automatically deducted through April 1, 2026Other $ (Needs to be $250 minimum) and the balance will be paid monthly through April 1, 2026Please contact me in regard to a scholarship application. (Scholarships are available on a case-by-case basis.) If you are applying for a scholarship request please fill out this form. Our Financial advisory board will only consider scholarship requests if the scholarship form is filled out with all the information that is required. Once done please come back to this page to finish your registration. I would like to kindly donate to the CHS Scholarship fund: $ Total $250.00 I would like to pay today:Full amount$250.00 minimum$ Payment Credit Card Check (Only if agreed on before filling in this form) / Mail-in Check Credit Card We accept Visa, MasterCard, American Express, Discover Credit Card Number Security Code Name on Card1 - January2 - February3 - March4 - April5 - May6 - June7 - July8 - August9 - September10 - October11 - November12 - December Expiration Month2026202720282029203020312032203320342035 Expiration Year (available case-by-case)Billing Address Street Address City State / Province Postal / Zip CodePlease SelectUnited StatesAfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanThe BahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChilePeople's Republic of ChinaRepublic of ChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongoCook IslandsCosta RicaCote d'IvoireCroatiaCubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonThe GambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorthern MarianaNorwayOmanPakistanPalauPanamaPapua New GuineaParaguayPeruPhilippinesPitcairn IslandsPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint BarthelemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSomalilandSouth AfricaSouth OssetiaSpainSri LankaSudanSurinameSvalbardSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTristan da CunhaTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamBritish Virgin IslandsUS Virgin IslandsWallis and FutunaWestern SaharaYemenZambiaZimbabweOther Country Terms of agreement * I agree that in the event of an emergency, Chabad Hebrew School has permission to arrange for any necessary first-aid or care by a licenced physician /first-aid worker.Chabad Hebrew school has permission to use my child’s photo in its publicity materials. Signature: We look forward to a wonderful year of learning and growth!All students will automatically be reenrolled for Chabad Hebrew School 2026- 2027 on June 1st unless otherwise requested. Submit Should be Empty: This page uses TLS encryption to keep your data secure.