Application Form

Date applied:

Enrolment Year:

Our intake is generally in January of each year. Occasionally there are spots available at other times.

If you are interested in mid-year intake, please specify which month:

Child's Name: Date of Birth:

Child's Jewish Name:

Mother's First Name: Mother's Surname:

Home Address: Suburb: Post Code:

Home Phone: Mobile:


Father's First Name: Father's Surname:

Mobile: Email:

Do you belong to Chabad Malvern shul?

Is the mother of this child Jewish?

Is the father of this child Jewish?

Are there any Conversions in the family? Please indicate who has undergone conversion and through which organisation.

Which Synagogue were you married in?
Who was the officiating Rabbi?
Is your child a returning sibling to our creche?

Days of Care Required:
Flexible with days:

How did you find out about us?

Other comments: