cTeen Registration - Harford Chabad

We are currently accepting application forms for the 2017-2018 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.

Our cost per student is Tuition is
$150 Per Course + $300 for the Shabbaton
Student Profile
Child's Name*

First Name Last Name
Hebrew Name
School
Birth Date

Month Day Year
Previous Jewish education

Where?
Grade entering* As of September 2017
Parent Information
Father's Full Name*

First Name Last Name
Father's Cell Phone Number

Area Code Phone Number
Father's E-mail
Mother's Full Name*

First Name Last Name
Mother's E-mail
Mother's Cell Phone Number

Area Code Phone Number
These biological parents of the child were born Jewish* Select all that apply

Mother Father Other - Contact Me
Are there any conversions in the family?*

Yes No
Are there any adoptions in the family?*

Yes No
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.
Terms of Agreement

As the parent(s) or legal guardian of the above child(ren), I/we authorize any adult acting on behalf of Chabad of Harford County or Chabad's Harford 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,Chabad of Harford County or Chabad's Harford 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.

As the parent(s) or legal guardian of the above child(ren), I/we authorize allow our child to be photographed while participating in Chabad of Harford County's activities and that these pictures may be used for any and all marketing purposes and release Chabad of Harford County and any of its officers, agents, employees and volunteers from liability for such use.

I/we are aware that acceptance to Chabad of Harford County programs is not an endorsement of the Childs Halachic status as a Jew.

If necessary, the Child's status will need to be verified prior to any Bar/Bat Mitzvah being performed at Chabad.
*

I accept
Full Name*

First Name Last Name
Initials*
Should be Empty:

This page uses TLS encryption to keep your data secure.

Student Profile

Parent Information

More in this section