We are currently accepting application forms for the 2019-2020 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 Morah Chanie Baron at 410-530-6229 or Morah Chaya Sufrin at 443-280-0340.

Please note that one registration form per child is needed.

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

Student Profile
 
First Name
Last Name
Hebrew Name
DOB

 Year:  

Hebrew Birthday:  

Jewish Birthday Calculator: 
http://lubavitchhowardcounty.org/6228

School
Grade Entering
Hebrew Reading Proficiency None Somewhat Well
Previous Jewish Education Yes No
Where?

Were there any conversions or adoptions in your family?

Yes No

If Yes please describe (converted by whom etc..) and provide a copy of conversion certificate:

Please be aware that Gan Israel/Chabad-Lubavitch Centers can only officiate Bar/Bat Mitzvahs for children who are halachically Jewish. A child is halachically Jewish if: A) The child, their mother and maternal grandmother were born Jewish. OR B) The child, their mother or their maternal grandmother underwent a halachic conversion. Please provide conversion certificate to clarify if it was a halachic conversion.

Parent Information
 
Father's Name
Phone
Mother's Name
Phone
Address
City
State
Zip
Email Address


Emergency Information
 
Emergency Contact 1
Phone
Emergency Contact 2
Phone

Doctor
Address
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 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!