  
2012
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APPLICATION FORM
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CHILD 1
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CHILD 2
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Last Name:
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First Name:
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Hebrew Name:
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Date of Birth:
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Approx. time of day
of birth*
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Public School Attending:
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Year
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Member of Chabad Double Bay
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*Necessary in order to determine Hebrew birthday
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Please comment on your child’s knowledge in Hebrew(reading & writing), Jewish History & Holidays
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1. None
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2. Some
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3. Good
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Other comments:
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Home Address:
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City, State, Post Code:
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Home Phone: ( )
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Fathers Name: Business Phone: ( ) Mobile: ( )
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Mothers Name: Business Phone: ( ) Mobile: ( )
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Emergency Name 1: Phone: ( )
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Emergency Name 2: Phone: ( )
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I enclose $150 to cover the cost of one term Hebrew School fee per child.
Cheque to be made out to Chabad Double Bay
Please let us know if you are interested in: □Bar/Bat Mitzvah Preparation
□Information on Adult Education
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