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Programs Village Kids Hebrew

Hebrew School Registration

Student Information
Full Name*
First Name Last Name
Hebrew Name*
First Name Last Name
Birth Date*

Day Month Year
School*
Previous Jewish Education
Year Level in 2024*

Address*

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

Additional notable Information Please let us know if there are any allergies or other important information we need to be aware of.
Parents Information
Father's Name*
First Name Last Name
Father's Cell*

Phone Number
E-mail Father
Mother's Name*
First Name Last Name
Mother's Hebrew Name
Mother Jewish by:*

BirthConversionNot Jewish
Name of Rabbi who did the conversion
Mother's Cell*

Phone Number
E-mail Mother
I am willing to assist in school activities, please contact me
*

I hereby authorise Chabad Dingley staff and/or volunteers to photograph my child and use the photographs for promotional purposesI hereby authorise a Chabad Dingley staff and/or volunteer to obtain any medical care necessary for my child, including from a medical practitioner, hospital or ambulance service. I understand that transportation to receive medical care may include an ambulance and I agree to pay for any costs involved with seeking medical care for my child. I understand that in the case of an emergency of significant illness or injury attempts will be made to contact myself or an authorised nominee, as soon as practical*
Payment
Fees will be charged at the beginnig every term*

$150 per term
Please charge my card at the beginning of every term
No child will be turned away due to lack of funds. Contact us if you need assistance.

Payment

Credit Card Bank Transfer

Should be Empty:

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