Printed from

Registration 2021/2022

  • Please fill out this form and submit it together with your tuition, registration and book fees.

  • General Information:

  • Religious & Educational History: 

  • Second Child

  • Religious & Educational History: 

  • Third Child

  • Religious & Educational History: 

  • Fourth Child

  • Religious & Educational History: 

  • Contact Information:

  • Emergency Contact Person:(other than parent/guardian)

  • Authorized Persons To Pick Up Your Child: (other than parents/guardians)

  • Method of Payment:

  • $0.00
    Credit Card
    Billing Address
  • Medical Information:

  • 1. The parent/Guardian will be called.

    Note:If the parent/guardian is unavailable, the emergency contact person designated by the parent/guardian will be called.

    2. Child's physician will be called.

    3. If these efforts are unsuccessful the following steps will be taken (order may vary depending on the situation):

    a. Another physician will be called.

    b. The child will be taken to the nearest emergency room accompanied by a staff member.

    c. An ambulance will be called to take the child to the nearest emergency room accompanied by a staff member.

    In the event of an emergency, if I cannot be reached, I give consent for a Chabad staff member to transport my child to the nearest emergency facility, or to have my child transported by ambulance.

  • Should be Empty:
Secure This page uses TLS encryption to keep your data secure.