Cheder Registration

Form Name

Parents information

Family Name

Father's Name

Mother's Name

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Home Phone Number

Mother's Mobile Number

Father's Mobile Number

Mother's E-mail Address

Father's E-mail Address

Child's information

How many children are you registering for Cheder?

Child 1

Child's Name

First NameLast Name

Child's Hebrew Name

Date of Birth

DayMonthYear

School Year

School

Child 2

Child's Name

First NameLast Name

Child's Hebrew Name

Date of Birth

DayMonthYear

School Year

School

Child 3

Child's Name

First NameLast Name

Child's Hebrew Name

Date of Birth

DayMonthYear

School Year

School

STUDENT/FAMILY INFORMATION:

In case of illness or injury of a child at cheder, every effort will be made to contact the parent or guardian.

IN AN EMERGENCY, CALL:

OPTION 1

Call Option 1 - Name

Option 1 - Tel Number

Option 1 - Mobile Number

OPTION 2

Call Option 2 - Name

Option 2 - Tel Number

Option 2 - Mobile Number

Personal history

Is the Child's father Jewish

YesNo

Is the Child's mother Jewish

YesNo

Are there any conversions in the family

YesNo

If YES, please specify

Are the child's parents living together

YesNo

If NO, other address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Other home phone number

Who lives here

MotherFather

Does your child attend any special eduation program in school?

Special education

YesNo

If yes, what special education

Is your child on any special medication that the school should be aware of?

Special medication

YesNo

If yes, what medication

Does your child have any allergies

YesNo

If yes, what allergies

Child's previous cheder education

How many years

Number of days per week

At what synagogue

Has your child studied hebrew

YesNo

If yes, how many years

Payment option

How Would you like to pay

CashChequeStanding Order 3

GIFT AID

Please tick here if you are a UK Tax Payer and your donation and/or future donations can be counted as Gift Aid. Thank You!

I understand that in the event of an emergency the staff at Chabad will contact me immediately. In the event that I, or my named emergency contact(s) cannot be reached, I understand that emergency treatment and / or advice will be sought for my child and I will be informed as soon as possible.

I understand that any damage to Chabad property that my child causes, I will be liable for. We take photos for the media, our website and Facebook. If you feel strongly against this please write to tell us and we will of course respect those wishes. By clicking "Ok", you will be agreeing to the above and someone from Chabad will be in touch with you shortly to confirm your child's enrolment.