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Hebrew Gems

Welcome to the Hebrew Gems enrollment form.

If you would like to view the more information about Hebrew Gems, please visit the Gems website www.cgems.org.au or by clicking here
Register your child/ren to Hebrew Gems!
Student 1 Full Name
First Name Last Name
Hebrew Name
If known
Gender
Date of Birth

Day Month Year
Grade in 2026
School in 2026
Medical conditions
Drug/Food Allergies
Is an EPIPEN required
Management plan for above Child 1

I will email [email protected]
Is Tetanus Booster up to date
Any previous Jewish education? If so, name of (after)school
If previously attended
Hebrew Reading Proficiency

NoneSomewhatWell
Previous Jewish Education

A littleMediumA lot
Student 2 Information
Student 2 Full Name
First Name Last Name
Hebrew Name 2
If known
Gender 2
Date of birth 2

Day Month Year
Grade in 2026 2
School in 2026 2
Medical conditions 2
Drug/Food Allergies 2
Is an EPIPEN required 2
Management plan for above Child 1

I will email the plan to [email protected]
Is Tetanus Booster up to date 2
Any previous Jewish education? If so, name of (after)school 2
Hebrew Reading Proficiency 2

NoneSomewhatWell
Previous Jewish Education 2

A littleMediumA lot
Parents Information
Mothers Name
First Name Last Name
Father Name
First Name Last Name
Mother phone
Home phone
Mother Mobile
Mother E-mail
Father phone
Home phone
Father Mobile
Father E-mail
Marital Status
For mailing and sensitivity towards students

Address (Child's primary address)

Is the natural mother of the child Jewish

YesNo
Are there any conversions in the family

Yes - Please answer next questionNo
If yes, please provide conversion details
Shul Affiliation (if any)
Full name of emergency contact
First Name Last Name
Relationship to child
Emg home phone
Emg mobile
GP Phone
Local GP Name
Session (day) enrollment
Students attend Hebrew School for one day a week. Please select your prefered day below. Classes for prep to grade six run on all days.
Class sessions Choice of days are subject to availability

Monday 4.00 - 5.30pmTuesday 4.00 - 5.30pm
(Optional) Please put my child/ren in the same class as
Is there anything else you would like us to know about?
Declaration of Parent / Guardian
I hereby authorise Chabad House Glen Eira leaders and staff to obtain any medical care necessary for my child. I understand that in the case of emergency of any significant illness or injury, attempt will be made to contact myself when practical. I agree to pay for any cost that may occur as a result of the injury/illness. I acknowledge my child may be participate in activities within and outside the Chabad grounds. I authorise my child to participate in these activities. I hereby authorise Chabad House Glen Eira to photograph my child and to use the photographs at their discretion.
I agree to the above declaration

Checked
Declaration Name
First Name Last Name
Deposit Your deposit will be deducted from your term 1 fees

$50

Secure online payment*

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Credit Card

Direct Debit
I give Chabad Glen Eira Hebrew Gems permission to debit $250per child each term from the above credit card. If this is an issue please contact us prior to the start of the year to make other arrangements.
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Register your child/ren to Hebrew Gems!