Printed fromChabadofMaine.com

Chabad Hebrew School

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

ב"ה

Register

Your Information:
Student Name*

First Name Last Name
Hebrew Name*
Age of September 1st*
Date of Birth*

Month Day Year
Hebrew Birthday*
Gender*

Male Female
School Attending*
Grade*
Previous Hebrew School Experience?*

Yes No
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 Name Last Name
Mother’s Hebrew Name [if applicable]
Mother’s Mobile Number*

Area Code Phone Number
Mother’s E-mail*
Father’s Name*

First Name Last Name
Father’s Hebrew Name [if applicable]
Father’s Mobile Number*

Area Code Phone Number
Father’s E-mail*
Indicate if parents are Jewish by birth, conversion or non-Jewish: (Mother, Father)*
Home Phone Number*

Area Code Phone Number

Address*

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

Marital Status:*

Married Single Divorced
Class Information
Please specify which day of the week you would like Hebrew School 2 You:*
First Preference Time of day*
Second Preference Time of day*

Address where classes will be held*

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

Is there another family you would like to join with?*
Total:

$0.00

Yes, I'd like to donate the cost of processing this transaction by adding 2.5%

Payment:

Credit Card Check/Cash

Postal / Zip Code

Country

Should be Empty:

This page uses TLS encryption to keep your data secure.

Educate Your Child... Educate a Generation