Hebrew School 2 You - Chabad of Maine

Your Information:
Student Name*
First NameLast Name
Hebrew Name*
Age of September 1st*
Date of Birth*
MonthDayYear
Hebrew Birthday*
Gender*
MaleFemale
School Attending*
Grade*
Previous Hebrew School Experience?*
YesNo
Is there anything special that you would like us to know about your child? [allergies, specific health notes, etc.]?
Parent Information
Mother’s Name*
First NameLast Name
Mother’s Hebrew Name [if applicable]
Mother’s Mobile Number*
Area CodePhone Number
Mother’s E-mail*
Father’s Name*
First NameLast Name
Father’s Hebrew Name [if applicable]
Father’s Mobile Number*
Area CodePhone Number
Father’s E-mail*
Indicate if parents are Jewish by birth, conversion or non-Jewish: (Mother, Father)*
Home Phone Number*
Area CodePhone Number

Address*

Address where classes will be held*

Payment:

Credit Card Check/Cash

Postal / Zip Code

Country

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Parent Information