Printed from BournemouthChabad.org

Registration form

Registration form

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If you have any questions, feel free to contact our Hebrew School principal,
Mrs. Chanchi Alperowitz, at chanchialperowitz@gmail.com

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STUDENT 1 INFORMATION

Family Name

Is the natural mother of the child Jewish?

Were there any conversions or adoptions in the child's immediate or extended family? Yes No - If yes, please explain

Acceptance to Hebrew School is not an endorsement of the childs Halachic status as a Jew. If necessary, the childs status will need to be verified prior to any Bar/Bat Mitzvah being performed at Chabad.

Has your child had any previous Hebrew Education?
Yes No --- If yes, where?

Does Your child read basic Hebrew? Yes No

Does your child have a learning disability? Yes No

If yes, please explain

First Name
Hebrew Name
Date of Birth / /
DD / MM / YYYY format
  Age Gender
Class Entering in 2017-18 
School Attending 2016/2017
Home Address
City, Post Code

 

 

STUDENT 2 INFORMATION

Family Name

Is the natural mother of the child Jewish?

Were there any conversions or adoptions in the child's family? Yes No - If yes, please explain

Acceptance to Hebrew School is not an endorsement of the childs Halachic status as a Jew. If necessary, the childs status will need to be verified prior to any Bar/Bat Mitzvah being performed at Chabad.

Has your child had any previous Hebrew Education?
Yes No --- If yes, where?

Does Your child read basic Hebrew? Yes No

Does your child have a learning disability? Yes No

If yes, please explain

First Name
Hebrew Name
Date of Birth / /
DD / MM / YYYY format
  Age Gender
Class Entering in 2017-18 
School Attending 2016/2017
Home Address
City, Post Code

 

 

STUDENT 3 INFORMATION

Family Name

Is the natural mother of the child Jewish?

Were there any conversions or adoptions in the child's family? Yes No - If yes, please explain

Acceptance to Hebrew School is not an endorsement of the childs Halachic status as a Jew. If necessary, the childs status will need to be verified prior to any Bar/Bat Mitzvah being performed at Chabad.

Has your child had any previous Hebrew Education?
Yes No --- If yes, where?

Does Your child read basic Hebrew? Yes No

Does your child have a learning disability? Yes No

If yes, please explain

First Name
Hebrew Name
Date of Birth / /
DD/ MM / YYYY format
  Age Gender
Class Entering in 2017-18 
School Attending 2015/2016
Home Address
City, Post Code


PARENT INFORMATION

 

 

Father

Mother
Father's Name Mother's Name
Hebrew Name Hebrew Name
Date of Birth / /
DD / MM / YYYY format
Date of Birth / /
DD / MM / YYYY format
Home Tel. Home Tel.
Work Tel. Work Tel.
Mobile #: Mobile #:
Occupation Occupation
Email Email

MEDICAL INFORMATION

Persons to be contacted in case of an emergency when parents cannot be reached (Please provide 2 contacts)

Name

Phone

Relationship to Child

Name

Phone Relationship to Child

In an emergency, when you cannot reach either parent, I authorize the school to call:
Family Doctor Phone

CONFIDENTIAL: Does your child have any allergies or other medical condition we should be aware of?
If yes, please describe them and indicate special precautions or care needed.

As the parent(s) or legal guardian of the above child, I/we authorize any adult acting on behalf of Chabad Hebrew School to hospitalize or secure treatment for my child, I further agree to pay all charges for that care and/or treatment. It is understood that if time and circumstances reasonably permit, Chabad Hebrew School personnel will try, but are not required, to communicate with me prior to such treatment. I hereby give permission for my child to participate in all school activities, join in class and school trips on and beyond school properties and allow my child to be photographed while participating in Chabad Hebrew School activities and that these pictures may be used for marketing purposes.
I Accept

Name: Initials:


TUITION

Full year tuition: £350.00          Chabad members: £250.00

 We are members of Chabad We are not members of Chabad 

A limited number of scholarships are available upon request; no child will be turned away for lack of funds.

 
PAYMENT:

The full balance can be paid upfront, or for ease of payment, it may be split into quarterly or monthly payments between September 2017 and June 2018.

 

Please make cheques payable to: Chabad of Bournemouth and mail to Chabad, 20 Lansdowne Road, Bournemouth

BH1 1SD

Or do a BACS payment to:

Account Name:

Chabad Lubavitch of Bournemouth

Account Number:

1011 4183

Sort Code:

83-04-02

 

For any questions about payment please contact Rabbi Bentzion on 07494 567177

 

Optional Comments:
 
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