Registration -
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  • Submitting this form is just one part of the registration process.  Other prerequisites for registration are:
    • Signing of the state mandated Distracted Adult Flier and Influenza Information Sheet - available  by request as a PDF
    • Submitting both your chid's health and immunization form
    • Submitting the $350 registration fee

  • General Student Information


  • 2.General Student  Infomation 

    Child #2

  • 3.General Student Information


  • 4.General Student Information


  • 5.General Student Information

    Child #5

  • 6.General Student Information

    Child #6

  • Family Information

  • Medical Information

  •  Waiver

  • Release of Liability:

    I hereby voluntarily release from liability and waive any and all claims or causes of action for personal injury or death occurring to the student or others, or property damage arising from or relating to participation in the above activities, and whether arising from the negligence of Lamplighters Hebrew Academy or otherwise, against Lamplighters Hebrew Academy or any of its officers, agents, directors, teachers, or employees. I hereby release Lamplighters Hebrew Academy from liability for myself and my heirs, executors, administrators and assigns, and I shall indemnify and hold harmless Lamplighters Hebrew Academy from any and all such claims or causes of action, including attorney’s fees or damage to personal property. My signature on this form shall constitute an informed and knowing consent and waiver as required by law. I hereby acknowledge that I understand the effect of releasing Lamplighters Hebrew Academy of all such liability, including that caused by negligence.In case of an emergency, I give permission for my child to receive medical treatment.

    I, the undersigned parent or guardian do hereby consent to any x-ray examination, anesthetic, medical or surgical diagnosis, or treatment and hospital service that may be rendered to said minor under the general or special treatment, and, hospital service that may be rendered to said minor under the general or special instructions, of our physician or other physician called in any emergency by the Lamplighters Principal, the Rabbi, or responsible adult, in the event I/we cannot be reached, whether such diagnosis or treatment is rendered at the office of said physician or at a licensed hospital. It is understood that conscientious effort will be made to notify me or my spouse before such action is taken, but if this is not possible, the expense of this service will be accepted by me/us. It is understood that this consent is given in advance of any specific diagnosis or treatment being required. This consent shall remain effective until revoked. (By entering your name in the box below, you are effectively providing your signature, indicating that all the information on this form is true and accurate, to the best of your knowledge.)

    I give permission for my child/ren to be photographed and their photos to be placed in our advertisements, brochures, and websites.  This includes but is not limited to: and other social media platforms.

  • Yearly Field Trip Permission Form:

  • $0.00
    Credit Card
    Checks Should be mailed to: Chabad of Charlotte County, 424 W Henry Street Punta Gorda, FL 33950
    Billing Address
  • Should be Empty:
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Lamplighters Hebrew Academy Charlotte County