Printed from ChabadatShortHills.org

Medical Form

Medical Form

  • As part of our ongoing commitment to provide your child with the opportunity to reach his /her full potential, please complete the form below. A form is necessary for each child. 

  • Child's Information

  • -
  • Medical/Emergency Information

  • Does your child receive support services in or out of his/her school day (special education/ resource support, paraprofessional, one-on-one aide, tutor)? 


  • I/we authorize any adult acting on behalf of Chabad at Short Hills Hebrew School to hospitalize or secure treatment for my child, I further agree to pay all charges for that care and/or treatment. It is understood that if time and circumstances reasonably permit, Chabad at Short Hills Hebrew School personnel will try, but are not required, to communicate with me prior to such treatment. 

  • Should be Empty:
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