Family Information Form
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Family Name
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Address
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City
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Zip Code
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Home Phone
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Father's Name
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Hebrew if Available
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Address (if different)
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City
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Zip Code
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Home Phone
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Father's Email
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Father's Cell Phone
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Cell Phone Carrier
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Mother's Name
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Hebrew if Available
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Address (if different)
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City
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Zip Code
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Home Phone
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Mother's Email
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Mother's Cell Phone
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Cell Phone Carrier |
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Marital Status of Parents
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Does someone other than the parent(s) care for your child(ren)?
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If yes, please give name
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Phone Number
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Are both parents Jewish? Yes No
To your recollection have there been any conversions or adoptions in the family? No Yes
If yes please explain :
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Child Information |
Attending Chabad Hebrew Scool |
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1. Child's Name
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Hebrew Name
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DOB
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Hebrew DOB (if not known, please indicate time of birth) |
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Grade Entering
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Anything we should know about your child: |
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Any allergies |
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Attending Chabad Hebrew Scool |
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2. Child's Name
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Hebrew Name
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DOB
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Hebrew DOB (if not known, please indicate time of birth) |
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Grade Entering
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Anything we should know about your child: |
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Any alleriges |
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Attending Chabad Hebrew Scool |
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3. Child's Name
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Hebrew Name
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DOB
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Hebrew DOB (if not known, please indicate time of birth) |
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Grade Entering
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Anything we should know about your child: |
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Any alleriges |
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Attending Chabad Hebrew Scool |
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4. Child's Name
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Hebrew Name
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DOB
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Hebrew DOB (if not known, please indicate time of birth) |
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Grade Entering
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Anything we should know about your child: |
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Any alleriges |
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Please list name and age of other siblings.
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