Application Form

APPLICATION FORM
Is you child a new or returing student?

New studentReturning student
Student Information
Child's Name*
First Name Last Name
Child's Hebrew Name*
Birth Date*

Month Day Year
Grade entering for the 2026-27 school year*
Current school*
Please let us know a little bit about your child! (Allergies or medical condition?)*
Parent Information
Father's Name*
First Name Last Name
Father's E-mail*
Father's Cell*
Mother's Name*
First Name Last Name
Mother's E-mail*
Mother's Cell*
Parents Marital Status* Married, Separated, Divorced
Was the students biological maternal grandmother born Jewish?**

YesNoOther
Any conversions in the family?*

YesNo
If yes, Please provide details

Home address where child resides*

Payment

Credit Card

We accept Visa, MasterCard, American Express, Discover
Credit Card Number	Security Code
Name on Card
Expiration Month	Expiration Year

Billing Address

Street Address

City

State / Province

Postal / Zip Code

Country

I would like to receive news and updates from Chabad NMB East by email. I understand that information I provide to Chabad NMB East will be used according to its Privacy Policy and I can unsubscribe at any time.
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 hereby give permission for my child to participate in all school activities, 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 agree
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APPLICATION FORM