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Chai Hebrew School Returning Student 2021/2022
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Family Name
*
How many recurring students would you like to register?
Please Select One
1
2
3
4
Child 1
*
Child 1 - First Name
*
Child 1 - Last Name
*
Month Child 1 Born
Please Select One
January
February
March
April
May
June
July
August
September
October
November
December
*
Child 1 - Date of Birth
*
Child 1 - Time of Birth
Please Select One
Morning
After Nightfall
Child 1 Hebrew Name
Child 1 Gender
Please Select One
Male
Female
Child 1 Grade Entering
Please Select One
JK
SK
1
2
3
4
5
6
Chai Bar Mitzvah Club
Child 1 Grade Entering
Please Select One
JK
SK
1
2
3
4
5
Chai Bat Mitzvah Club
Child 2
*
Child 2 - First Name
*
Child 2 - Last Name
*
Month Child 2 Born
Please Select One
January
February
March
April
May
June
July
August
September
October
November
December
*
Child 2 - Date of Birth
*
Child 2 - Time of Birth
Please Select One
Morning
After Nightfall
Child 2 Hebrew Name
*
Child 2 Gender
Please select One
Male
Female
Child 2 Grade Entering
Please Select One
JK
SK
1
2
3
4
5
6
Chai Bar Mitzvah Club
Child 2 Grade Entering
Please Select One
JK
SK
1
2
3
4
5
Chai Bat Mitzvah Club
Child 3
*
Child 3 - First Name
*
Child 3 - Last Name
*
Month Child 3 Born
Please Select One
January
February
March
April
May
June
July
August
September
October
November
December
*
Child 3 - Date of Birth
*
Child 3 - Time of Birth
Please Select One
Morning
After Nightfall
Child 3 Hebrew Name
*
Child 3 Gender
Please select One
Male
Female
Child 3 Grade Entering
Please Select One
JK
SK
1
2
3
4
5
6
Chai Bar Mitzvah Club
Child 3 Grade Entering
Please Select One
JK
SK
1
2
3
4
5
Chai Bat Mitzvah Club
Child 4
*
Child 4 - First Name
*
Child 4 - Last Name
*
Month Child 4 Born
*
Child 4 - Date of Birth
*
Child 4 - Time of Birth
Please Select One
Morning
After Nightfall
Child 4 Hebrew Name
*
Child 4 Gender
Please select One
Male
Female
Child 4 Grade Entering
Please Select One
JK
SK
1
2
3
4
5
6
Chai Bar Mitzvah Club
Child 4 Grade Entering
Please Select One
JK
SK
1
2
3
4
5
Chai Bat Mitzvah Club
*
Email
Total
Wed, 15 January 2025 15 Tevet 5785