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Mimi Dwek Hebrew School – Registration Form

Hebrew School Registration

Mimi Dwek Hebrew School · St John's Wood Synagogue

Please complete one form per family. If you are registering more than one child, add each child's details below — we'll only ask you for the family and parent information once.

01

Children

How many children are you registering?*

02

Parent / Guardian details

Mother's / Parent 1 name*

Father's / Parent 2 name

Home address*

Mother's / Parent 1 email*

Father's / Parent 2 email

Mother's / Parent 1 mobile*

Father's / Parent 2 mobile

Home telephone number (optional)

Parents / guardians are*

Married Separated Divorced Other / Prefer not to say

03

Medical & educational information

Does your child/children take any medication, have any allergies, special educational needs, medical conditions or other needs that we should be aware of?*

Yes No

Please give details

Has your child/children previously attended a Jewish school, Hebrew School, Cheder or other Jewish education programme?*

Yes No

Please give details

Is there anything else it would be helpful for the Hebrew School team to know about your child/children? (optional)

04

Background

How did you hear about the Mimi Dwek Hebrew School?*

St John's Wood Synagogue Friend/family Current Hebrew School family Website Social media Other

Please specify

Are you members of St John's Wood Synagogue?*

Yes No

05

Permissions & consent

Photography consent

I give permission for photographs of my child/children taken during Hebrew School activities to be used in St John's Wood Synagogue communications, including newsletters and community publicity.

Yes No

Emergency medical consent

In the event of an emergency, if I cannot be contacted, I authorise the Hebrew School team to seek appropriate medical assistance for my child.

I agree

Emergency contact name*

Relationship to child*

Emergency contact mobile number*

Second emergency contact name (optional)

Relationship to child (optional)

Second emergency contact mobile (optional)

06

Declaration

I confirm that the information provided on this form is accurate, and that I will inform the Hebrew School of any relevant changes.

I confirm the above

Parent/guardian full name*

Date*

Signature (type your full name to sign)*

Sent directly to the Hebrew School office

Mimi Dwek Hebrew School · St John's Wood Synagogue