Chabad Hebrew School Student Info Form


Student Information


Birth date:            Grade:


City: Prov.: Postal Code:

Parent Contact Information

Parent 1 Name:

Home Phone Number:       Mobile Phone: 

E-mail address:

Parent 2 Name:

Home Phone Number:         Mobile Phone:

E-mail address:

Emergency Information

In case of emergency, when neither parent can be reached, please provide a contact who will take responsibility for our child.

Emergency contact (other than parent):

Home Phone: Mobile Phone:


Child's Doctor: Phone Number:


Health Card Number:

Allergies or Special needs:

If we, our emergency contact, or our physician (as noted on this form) cannot be reached in case of medical/surgical emergency, we hereby give permission to the physician or hospital selected by the school or its selected representative, to hospitalize, secure proper treatment for our child as named above. We understand that any cost will be our responsibility.
I accept Name: Initials:

Photo Release

 I hereby give permission to Chabad Hebrew School to use school photos of my children in any Chabad Hebrew school publication to promote the school. This includes print and online publications as well as social media.


Thank you and looking forward to a productive year of learning and growth.

If you have any questions, please don't hesitate to contact us: [email protected]