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Chabad Hebrew School

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

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Hebrew School Signup

Child Information
Child Name

First Name Last Name
Hebrew Name
Birth Date

Month Day Year
Grade Entering
Hebrew Reading Proficency
Parent Info
Which Parent is Jewish
Father's Name

First Name Last Name
Father's Email
Father's Phone Number

Area Code Phone Number
Mother's Name

First Name Last Name
Mother's Email
Mother's Phone Number

Area Code Phone Number

Address

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

Emergency Info
Emergency Contact's Name

First Name Last Name
Emergency Contact's Phone Number

Area Code Phone Number
Relationship to Children
Hebrew School Tuition Payment
Payment Amount*

Payment*

Credit Card eCheck

Postal / Zip Code

Country

PERMISSION TO OBTAIN EMERGENCY MEDICAL TREATMENT

By submitting this form, I give Chabad-Lubavitch of Berks County and its representatives permission to obtain medical treatment for my child in the event of an emergency. I also agree to indemnify and hold harmless Chabad-Lubavitch of Berks County and its representatives for all costs incurred in any medical treatment or ancillary services for my child.
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