Cheder Registration Form | www.chabadwimbledon.com

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

Please specify *

Are the natural mother and maternal grandmother of the children Jewish? *

Yes

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? *

Child 1

First Name *

Last Name *

Gender *

Birth Date *

Month

Day

Year

Current school child is attending *

Hebrew reading proficiency level *

I am registering my child for *

Cheder Registration 2020-2021

Additional Information

Does your child have any allergies? *

Yes

Please describe your child's allergies *

Does your child have any medical conditions? *

Yes

Please describe your child's medical conditions *

Does your child have any learning difficulties? *

Yes

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 *

Birth Date *

Month

Day

Year

Current school child is attending *

Hebrew reading proficiency level *

I am registering my child for *

Cheder Registration 2020-2021

Additional Information

Does your child have any allergies? *

Yes

Please describe your child's allergies *

Does your child have any medical conditions? *

Yes

Please describe your child's medical conditions *

Does your child have any learning difficulties? *

Yes

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 *

Birth Date *

Month

Day

Year

Current school child is attending *

Hebrew reading proficiency level *

I am registering my child for *

Cheder Registration 2020-2021

Additional Information

Does your child have any allergies? *

Yes

Please describe your child's allergies *

Does your child have any medical conditions? *

Yes

Please describe your child's medical conditions *

Does your child have any learning difficulties? *

Yes

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 *

Birth Date *

Month

Day

Year

Current school child is attending *

Hebrew reading proficiency level *

I am registering my child for *

Cheder Registration 2020-2021

Additional Information

Does your child have any allergies? *

Yes

Please describe your child's allergies *

Does your child have any medical conditions? *

Yes

Please describe your child's medical conditions *

Does your child have any learning difficulties? *

Yes

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