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Cheder Registration Form
Mother
First Name
*
Last Name
*
Email
*
Phone Number
*
Street Address
*
City
*
State/Province
*
Postal Code
*
Have there been any conversions or adoptions in the family?
*
Yes
No
Please specify
*
Are the natural mother and maternal grandmother of the children Jewish?
*
Yes
No
Please specify
*
Father
First Name
*
Last Name
*
Email
*
Phone Number
*
Share address of
Mother
Street Address
*
City
*
State/Province
*
Postal Code
*
How many children are you registering?
*
1
2
3
4
Child 1
First Name
*
Last Name
*
Gender
*
- Select -
Female
Male
Birth Date
*
Month
Month
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Day
Day
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Year
Year
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
2017
2018
2019
2020
2021
Current school child is attending
*
Hebrew reading proficiency level
*
- Select -
None
Somewhat
Well
I am registering my child for
*
Cheder Registration 2020-2021
Additional Information
Does your child have any allergies?
*
Yes
No
Please describe your child's allergies
*
Does your child have any medical conditions?
*
Yes
No
Please describe your child's medical conditions
*
Does your child have any learning difficulties?
*
Yes
No
Please describe your child's learning difficulties
*
Please add any notes or comments about your child
Emergency Contact Info
Emergency Contact Name
*
Phone Number
*
Relationship to Child
*
Child 2
First Name
*
Last Name
*
Gender
*
- Select -
Female
Male
Birth Date
*
Month
Month
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Day
Day
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Year
Year
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
2017
2018
2019
2020
2021
Current school child is attending
*
Hebrew reading proficiency level
*
- Select -
None
Somewhat
Well
I am registering my child for
*
Cheder Registration 2020-2021
Additional Information
Does your child have any allergies?
*
Yes
No
Please describe your child's allergies
*
Does your child have any medical conditions?
*
Yes
No
Please describe your child's medical conditions
*
Does your child have any learning difficulties?
*
Yes
No
Please describe your child's learning difficulties
*
Please add any notes or comments about your child
Emergency Contact Info
Emergency Contact Name
*
Phone Number
*
Relationship to Child
*
Child 3
First Name
*
Last Name
*
Gender
*
- Select -
Female
Male
Birth Date
*
Month
Month
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Day
Day
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Year
Year
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
2017
2018
2019
2020
2021
Current school child is attending
*
Hebrew reading proficiency level
*
- Select -
None
Somewhat
Well
I am registering my child for
*
Cheder Registration 2020-2021
Additional Information
Does your child have any allergies?
*
Yes
No
Please describe your child's allergies
*
Does your child have any medical conditions?
*
Yes
No
Please describe your child's medical conditions
*
Does your child have any learning difficulties?
*
Yes
No
Please describe your child's learning difficulties
*
Please add any notes or comments about your child
Emergency Contact Info
Emergency Contact Name
*
Phone Number
*
Relationship to Child
*
Child 4
First Name
*
Last Name
*
Gender
*
- Select -
Female
Male
Birth Date
*
Month
Month
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Day
Day
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Year
Year
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
2017
2018
2019
2020
2021
Current school child is attending
*
Hebrew reading proficiency level
*
- Select -
None
Somewhat
Well
I am registering my child for
*
Cheder Registration 2020-2021
Additional Information
Does your child have any allergies?
*
Yes
No
Please describe your child's allergies
*
Does your child have any medical conditions?
*
Yes
No
Please describe your child's medical conditions
*
Does your child have any learning difficulties?
*
Yes
No
Please describe your child's learning difficulties
*
Please add any notes or comments about your child
Emergency Contact Info
Emergency Contact Name
*
Phone Number
*
Relationship to Child
*
Permissions
emergency permission
*
I agree that in the event of an emergency, Cheder has my permission to arrange for any necessary first-aid or care by a licensed physician/first-aid worker. I will inform them in writing if otherwise. I have completed the Enrollment Form and agree to pay any balance according to the terms of agreement oulined above.
media permission
I agree that the Cheder has the permission to take photos of my child(s) and use my child's photo in it's publicity materials. The photos will not be used for any cause other than this.
Payment Options
Would you like to split the payment into multiple payments?
*
Yes
No, I would like to pay the full amount today
I would like to split my payment into
*
4 equal payments over 4 months
6 equal payments over 6 months
10 equal paymnets over 10 months
The first payment will be processed upon the form being submitted.
Discount Code
Chabad Wimbledon
info@chabadwimbledon.com
|
+44-20-8255-7770
|
42 St Georges Road, London, SW19 4ED
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