Hebrew School Registration

Hebrew School Registration

First Name *

Last Name *

Hebrew Name

Gender *

Female Male

Grade Entering in September *

Birth Date *

School Currently Attending

Family Information

Address *

Father's Name *

Father's Cell Phone Number *

Father's Email Address *

Mother's Name *

Mother's Cell Phone Number *

Mother's Email Addess *

Phone number should be used for updates *

Religious and Educational Information

Does your child read basic Hebrew? *

Yes No

Does your child have any learning difficulties with General Studies? *

Yes No

Does your child have an IEP? *

Yes No

Is the child's biological mother Jewish? *

Yes No

Is the child's biological father Jewish? *

Yes No

Is the child's maternal grandmother Jewish? *

Yes No

Are there any conversions and/or adoptions in the family? *

Yes No

Does your child have any allergies? If yes, please specify. *

Is your child taking any medications? If yes, please specify. *

Emergency Contact Name *

Emergency Contact Number *

Relation to child *

Cancel

log in