Hebrew School Registration - Chabad Lubavitch of Springfield

We are currently accepting application forms for the 2025-2026 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.

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

Student Information

Student Full Name

First Name Last Name

Birth Date

Month Day Year

Birth Day Before Sunset

YesNo

School Currently Attending

Grade Entering

Hebrew Reading Proficiency

NoneSomewhatWell

What previous education, if any, does your child have?

Any considerations, such as learning disorder or difficulty, the school should be aware of? (Confidential):

Does your child have any allergies?

YesNo

If Yes, Please Describe

Are you registering another child?

Second Student Full Name

First Name Last Name

Birth Date

Month Day Year

Birth Day Before Sunset

YesNo

School Currently Attending

Grade Entering

Hebrew Reading Proficiency

NoneSomewhatWell

What previous education, if any, does your child have?

Any considerations, such as learning disorder or difficulty, the school should be aware of? (Confidential):

Does your child have any allergies?

YesNo

If Yes, Please Describe

Parents Information

Father's Name

First Name Last Name

Father's E-mail

Father's Cell

Mother's Name

First Name Last Name

Mother's E-mail

Mother's Cell

Address

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Are the child's biological parents Jewish by birth?

Are there any conversions or adoptions in your family?

YesNo

If yes, please describe

Emergency Contact

Full Name

First Name Last Name

Phone Number

Relationship to Child

As the parent(s) or legal guardian of the above child/ren, I/we authorize any adult acting on behalf of Chai 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, Chai 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 Chai Hebrew School activities and that these pictures may be used for marketing purposes.

Please note, once your application is approved you will receive an invoice via e-mail. No child will be turned away due to lack of funds.

Signature*

Date*

Month Day Year