Student Information Full Name* First Name Last Name Hebrew Name Birth Date* 1 - January2 - February3 - March4 - April5 - May6 - June7 - July8 - August9 - September10 - October11 - November12 - December Month12345678910111213141516171819202122232425262728293031 Day20262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920 Year Approximate time of birth* DaytimeNightime School Attending* Grade Entering* Does your child have any allergies that we should be aware of? * YesNo Previous Jewish Education Second Child Full Name First Name Last Name Hebrew Name Birth Date 1 - January2 - February3 - March4 - April5 - May6 - June7 - July8 - August9 - September10 - October11 - November12 - December Month12345678910111213141516171819202122232425262728293031 Day20262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920 Year Approximate time of birth DaytimeNightime School Attending Grade Entering Previous Jewish Education Additional Information: Please let us know if there are any allergies or other important information we need to be aware of.* Parents Information Father's name* First Name Last Name Father's E-mail* Father's Cell* Area Code Phone Number Mother's Name* First Name Last Name Mother's E-mail* Mother's Cell* Area Code Phone Number Is the child's mother Jewish? * YesNo Are there any conversions in the family?* YesNo Are there any adoptions in the family?* YesNo Is your family affiliated with a congregation? If yes, which one?* NoYes The congregation we belong to: Authorized Pickup and Emergency Contacts Authorized Pickup* First Name Last Name Cel Number* Area Code Phone Number Emergency Contact* First Name Last Name Cel Number* Area Code Phone Number I hereby give permission for my child to be transported to and from field trips, and to participate in all JUDA activities. I understand that during the course of JUDA my child can be hurt. I accept the risk of possible injury and authorize any member of the Chabad Pod staff to render any necessary first aid. Furthermore, in an emergency case, I hereby authorize Chana Kugel, Rabbi Zevi Kugel or another staff member to have my child taken care of by a doctor or other medical person in any way the situation calls for. Permission Signature* I give permission to Chabad Pod, and those authorized by Chabad Pod, to take photographs and to make recordings of my children and my family, and to use them in original or modified form in all media now or hereafter known, with or without my name or information about me, for the promotion, public education, and/or fundraising activities of Chabad Pod. Media Signature* JUDA Hebrew Academy runs on Thursdays from 4:45 - 6:15 p.m. at The Chabad House - 249 West 60th St, starting September ____ and ending May 20th. I am considering the pick-up from school option. Conditions apply. Yes! Please contact me about this option. I am interested in an additional Sunday Supplementary Track. Yes! Please contact me about this option. Thank you for applying to JUDA Hebrew Academy by Chabad Pod. Please note that your registration is not complete until one of us has reached out to you to confirm your child's placement in JUDA. Please allow us 1-4 business days to contact you. Looking forward to partnering in your child's Jewish education, Best, Rabbi Zevi and Chana Kugel If you have any questions you can reach us at [email protected] Submit I would like to receive news and updates by email Should be Empty: This page uses TLS encryption to keep your data secure.
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