Greater Gainesville & Manassas

Hebrew School 2nd Child Registration

Please complete a separate registration for each child.

Click Here to return for first child/complete registration.

All information is confidential.

Any inquiries can be directed to: 571.445.0342 0r info@ChabadGainesville.com

2nd Student information

Which School does your child attend?

Grade entering this fall:

Previous Hebrew Education: Does your child read basic Hebrew?


Does your child speak Hebrew?


Does your child have any difficulties with his general studies?

if yes please specify

Is the biological Father Jewish?


Is the biological Mother Jewish?*


Where there any conversions or adoptions on the mothers side of the family?*

if yes please explain

*CHS welcomes every child, regardless of one's religious background or level of observance. CHS does not require membership or prior affiliations as a condition for enrollment. Acceptance to Hebrew School does not validate in anyway you or your child's Judaism. The process of being Bar and Bat Mitzvah through Chabad will require proof of mothers Judaism based on the guidlines of the Rabbinical court.

Medical information

Doctors Name

Doctors Phone Number

Doctors Address

Medical Coverage/ Insurance Company

Policy Number


(if any please list)

Medical Conditions:

If any please explain

Up to date with vaccinations?


Date of last tetanus shot


Permission for Emergency Medical Treatment:

As the parent(s) or legal guardian(s) I/we authorize any adult acting on behalf of the Chabad Hebrew School of Greater Gainesville & Manassas to hospitalize or secure treatment for my child. I further agree to pay for all charges for that care and/or treatment. It is understood that, if time and circumstances reasonably permit, Chabad Hebrew School will try 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 Gan Israel Hebrew School activities and that these pictures may be used for marketing purposes.


Please note all fields in this form are required, please write "NA" or "000" in fields that are not applicable.

Parent Signature

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