Full Name:
Hebrew Name
Mother's Hebrew Name
Address:
City:
State:
Zip code:
Home telephone number (s):
Cell phone number (s):
*Email:
Age
Occupation
Level of secular education?
Are you currently a student?
If no, in what subject did you get your degree?
Marital status
In order to gear the classes and lectures to your level of Jewish knowledge,
kindly fill out the following:
What is your knowledge of the following subjects:
On a scale of 0-3
0- No prior knowledge
1- Beginners
2- Intermediate
3- Advanced
A. Reading
The daily prayers?
Hebrew
Yiddish?
Rashi?
B. Chassidic Philosophy
Tanya
Jewish Mysticism/Kabbalah
Sichos (discourses of the Rebbeim)
C. Jewish Law
1. Laws of Shabbos
2. Laws of Kashrus
3. Laws Pertaining to Jewish Marriage
D. Chumash (the 5 Books of Moses)
1. Did you study the weekly Torah portion?
2. Did you study Rashi's commentary?
3. Did you study any other commentaries?
If so, which?
E. Formal Jewish Education
1. Have you ever studied in a post High School Yeshiva?
If so, where?
For how long?
When?
2. Have you ever attended a Jewish Day School or Afternoon Hebrew School?
If so, where?
For how long?
When?
F. Background
Please add any additional information you feel we should know about you.
G. Interest
What particular subjects of Jewish study are you interested in learning about this summer?
H. Comments
How did you hear about our Summer Program?
*Please register me for:
I am interested in attending for the following dates/and or classes:
Payment Information:
Full payment is required with your registration. Please submit the payment
portion of this form along with your name and address from above as well as the
dates you will be attending.
As no additional security features have been built into this site to protect
your credit card information, you can print out this registration form, then
fax or mail it. Checks should be made out to Machon Chana and be mailed along
with this form.
Amount that will be enclosed $
I am paying by check money order credit card
Please make checks and money orders payable to Machon Chana
Which credit card are you paying with?
Mastercard Visa AMEX Discover
Card Number.#
Exp. date:
Name on card:
