Register Online

We are currently accepting application forms for the 2018-2019 school year. Please fill out ALL fields of this form. If you have any questions or concerns you'd like to discuss with us, please contact us.

Please note that one registration form per child is needed.

We look forward to a wonderful year of learning and growth.

Student Profile
Student's First Name
Hebrew Name
Grade Entering
Hebrew Reading Proficiency None Somewhat Well
Previous Jewish Education Yes No
Where, Type of program, How many years, Other details?
Is the natural mother and maternal grandmother of the child Jewish? Yes No
Have there been any conversions or adoptions in the family? If Yes, please explain.

Goals for my child when signing up for Jewish Enrichment Program:

Parent Information
Father's Name
Mother's Name
Email Address
Emergency Information
Emergency Contact 1
Emergency Contact 2

CONFIDENTIAL: Does your child have any allergies, medical condition or academic challenges we should be aware of?
If yes, please describe them and indicate special precautions or care needed.

I give permission for my/our child to be in photos taken during Hebrew School activities and may be used in Chabad marketing and publicity.

Chabad's policy is that no one will be turned down due to lack of funds
For other options please call 860-232-1116 or email

Method of Payment: $825.00 per child

Please make checks payable to:
Chabad Youth 

2352 Albany Avenue West Hartford CT 06117

Will send Check or Cash Credit

Credit Card Info:
First Name:
Last Name:
City, State and Zip:

Card Type
Credit Card Number:
Exp. Date: (mm/yyyy)
Security Code: (Last 3 digits on back of card)