Hebrew Club Registration

2018-19 Registration is now OPEN!

Click HERE for the 2018-19 Calendar

• Jewish fun!
• Explore your heritage & traditions in a fun and hands on way!
• Wednesdays 1:50 pm - 4:00 pm
• FREE of charge!

Hebrew Club Enrollment Form

*First Name:
*Last Name:

Hebrew Name:
Gender: Male Female
*Date Of Birth dd/mm/yyyy:
*Grade the child is entering in September 2018: *Is your child in aftercare? Yes No
Name of Teacher: Room #:

Is the natural mother of the child Jewish?
Yes
No

Are there any Conversions in the family?
Yes No
If yes please explain:

Family Information:

Father's Name:
Address:
City: Post Code:
Home: Work: Mobile:

Mother's Name:
Address:
City: Post Code:
Home: Work: Mobile:

Which email would you like to use for communication?

Emergency Contact:

Name:
Relationship:
Telephone numbers:
Home: Work: Mobile:

Allergy Information:

Please provide any allergy or other medical information that we should know about:

I hereby give permission for the Chabad Russian Center Hebrew Club to seek medical attention for my child in the event of an accident / emergency and further give permission for my child to be transported to and from excursions.
Signed:

(Children will come directly from their classes to the Hebrew Club.)

Hebrew Club Classes are FREE: However, there is a one time $100.00 registration and book fee.