Registration Form | Chabad of SoMA NJ

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Serving the communities of Maplewood

and South Orange, NJ

Candle lighting in the SOMA area

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Hebrew School
Application

Child's First Name

Last Name

Street Address

City

Region/State/Province

Postal / Zip code

Child's Birthday

Mother's Full Name

Mother's Email

Mother's Cell

Synagogue Affiliation

Day School

Has your child previously attended Hebrew School *

Yes

No

If yes which Hebrew School?

Does your child have any learning difficulties with general studies? *

Yes

No

Is anyone in the family a Kohen or Levi? *

Yes

No

If yes, who?

Is Mother Jewish?

Yes

No

Does your child have any allergies? *

Yes

No

Father's Full Name

If yes, please describe

Father's Email

Does your child have any special needs, medication, or anything you feel we should know about? *

Yes

No

Father's Cell

Is Father Jewish? *

Yes

No

Emergency Contact Name

Relationship to Child

Cell number

Family Physician Name

Phone Number

Child' s Hebrew Name

HOME
ABOUT
SERVICES
EDUCATION
NEWS AND EVENTS
CONTRIBUTIONS
CONTACT
More

Use tab to navigate through the menu items.

Maplewood Jewish Center
113 Parker Avenue Maplewood, NJ 07040

(973) 762-5722
admin@maplewoodjewishcenter.org

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