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We are currently accepting application forms for the 2016-2017 school year. Please fill out ALL fields of this form. If you have any questions or concerns you'd like to discuss with us, please contact us.

Please note that one registration form per child is needed.

We look forward to a wonderful year of learning and growth.

Student Profile
Name
Last
Hebrew Name
DOB
School
Grade Entering
Hebrew Reading Proficiency None Somewhat Well
Previous Jewish Education Yes No
Where?
Natural mother of child Jewish? Yes No
Conversions / adoptions in family? Yes No
If yes, please describe
Any considerations, such as learning disorder or difficulty, the school should be aware of? (Confidential):
Which day would you like to attend? Sunday or Monday


Parent Information
Father's Name
Father Home Phone
Father Work Phone
Father Cell Phone
Father Email
Mother's Name
Mother Home Phone
Mother Work Phone
Mother Cell Phone
Mother Email
Address
City
State
Zip
Spouse Address (if different):


Emergency Information
Emergency Contact 1
Relationship to child
Home Phone
Cell Phone
Emergency Contact 2
Relationship to child
Home Phone
Cell Phone
Child Physician or Medical Facility
Physician Phone
Physician Address
Health Insurance
Group #
ID #
Up to date with vaccinations? Yes No
Last tetanus shot date? mm/dd/yr



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 Gan Israel 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, Gan Israel 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 Gan Israel Hebrew School activities and that these pictures may be used for marketing purposes.

I Accept

Name: Initials:

We look forward to a wonderful year of learning and growth!

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Mission Statement
Our Facility
Dates and Rates
Register Online
Pay Online
Our Staff
Contact Us
Support
Evaluation Form
Hebrew School Video
HS Calendars
Announcements

Choose Either our Sunday or Monday Program!

Check out our Hebrew School Video. CLICK HERE!

 
 
 

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Chabad Hebrew School 3939 Prince William Drive Fairfax, VA 22031 703-426-1980

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