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Registration

We are currently accepting application forms for the 2024-2025 school year. Please fill out ALL fields of this form. If you have any questions or concerns you would like to discuss with us, please feel free to contact us.

Please note that one registration form per child is needed.

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

The fee is £300 for Synagogue Members and £330 for Non-Members

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Childs Information

HOW MANY CHILDREN ARE YOU REGISTERING TODAY?*

CHILD 1 INFORMATION

Name

HEBREW NAME

Write Here

DOB*

Select Date ×

AGE*

Write Here

GENDER*

Boy

Girl

SCHOOL*

Write Here

GRADE ENTERING*

Write Here

PREVIOUS JEWISH EDUCATION?

Yes

No

IS THE NATURAL MOTHER OF THE CHILD(REN) JEWISH?*

Yes

No

WERE THERE ANY CONVERSIONS OR ADOPTIONS IN THE FAMILY?*

Yes

No

If yes please explain:

Write Here

ARE THE CHILD(REN)S PARENTS LIVING TOGETHER?*

Yes

No

CHILD 2 INFORMATION

Name

HEBREW NAME

Write Here

DOB*

Select Date ×

AGE*

Write Here

GENDER*

Boy

Girl

SCHOOL*

Write Here

GRADE ENTERING*

Write Here

PREVIOUS JEWISH EDUCATION?

Yes

No

IS THE NATURAL MOTHER OF THE CHILD(REN) JEWISH?*

Yes

No

WERE THERE ANY CONVERSIONS OR ADOPTIONS IN THE FAMILY?*

Yes

No

If yes please explain:

Write Here

ARE THE CHILD(REN)S PARENTS LIVING TOGETHER?*

Yes

No

CHILD 3 INFORMATION

Name

HEBREW NAME

Write Here

DOB*

Select Date ×

AGE*

Write Here

GENDER*

Boy

Girl

SCHOOL*

Write Here

GRADE ENTERING*

Write Here

PREVIOUS JEWISH EDUCATION?

Yes

No

IS THE NATURAL MOTHER OF THE CHILD(REN) JEWISH?*

Yes

No

WERE THERE ANY CONVERSIONS OR ADOPTIONS IN THE FAMILY?*

Yes

No

If yes please explain:

Write Here

ARE THE CHILD(REN)S PARENTS LIVING TOGETHER?*

Yes

No

PARENT INFOMATION

FATHERS NAME*

Name

HEBREW NAME

Write Here

HOME PHONE

Phone

FATHER'S MOBILE*

Phone

FATHER'S EMAIL*

Email Address

OCCUPATION*

Write Here

MOTHER'S NAME*

Name

HEBREW NAME

Write Here

HOME PHONE

Phone

MOTHER'S MOBILE*

Phone

MOTHER'S EMAIL*

Email Address

OCCUPATION*

Write Here

ADDRESS*

Recipient

Address line one

Address line two

Address line three

County

Postal Code

Persons to be contacted in case of an emergency when parents cannot be reached. Please provide at least two contacts.

NAME 1*

Name

PHONE*

Phone

RELATIONSHIP TO CHILD*

Write Here

DOES YOUR CHILD ATTEND ANY SPECIAL EDUCATION PROGRAM IN PUBLIC SCHOOL?*

Yes (please specify below)

no

Write Here

CONFIDENTIAL: DOES YOUR CHILD HAVE ANY ALLERGIES OR OTHER MEDICAL CONDITION, REQUIRE MEDICATION, OR ANY SPECIAL ABILITIES OR DISABILITIES WE SHOULD BE AWARE OF?*

Yes (please specify below)

no

Write Here

AS THE PARENT(S) OR LEGAL GUARDIAN OF THE ABOVE CHILD, I/WE AUTHORIZE ANY ADULT ACTING ON BEHALF OF Loughton Cheder TO HOSPITALIZE OR SECURE TREATMENT FOR MY CHILD. IT IS UNDERSTOOD THAT IF TIME AND CIRCUMSTANCES REASONABLY PERMIT, As Loughton Cheder PERSONNEL WILL TRY, BUT ARE NOT REQUIRED, TO COMMUNICATE WITH ME PRIOR TO SUCH TREATMENT. I HEREBY GIVE PERMISSION FOR MY CHILD TO PARTICIPATE IN ALL SCHOOL ACTIVITIES, JOIN IN CLASS AND SCHOOL TRIPS ON AND BEYOND SCHOOL PROPERTIES AND ALLOW MY CHILD TO BE PHOTOGRAPHED WHILE PARTICIPATING IN Cheder ACTIVITIES AND THAT THESE PICTURES MAY BE USED FOR MARKETING PURPOSES.*

I Accept

First Name

Last Name

INITIALS*

Write Here

PROGRAM OPTIONS*

Sunday Morning cheder 10:00am-12:00pm

Tuesday Evening Cheder 4:45-6:00 pm

Bar or Bat Mitzvah Classes

Your form has been submitted

Thank you

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