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Application For New Enrollment 25-26/תשפ"ה-תשפ"ו
Accepting Primary 25-26 applications Nov. 15-Dec. 10, 2024
Student Entering Grade
--Select--
Primary
1
2
3
4
5
6
Student
Last Name
First Name
Hebrew Name
Date of Birth (English)
Current School Child is Attending:
Parents' Marital Status
--Select--
Married
Widowed
Divorced
Student Lives With
--Select--
Father
Mother
Shul Affiliation
Rabbi
Family Rabbi
Phone Number
Language
English
Hebrew
Other
Please Specify
Contact Information
Father
Home Phone Number
Address
City
State
Zip
Mother
Home Phone Number
Address
City
State
Zip
Mother
Maiden Name
Mother's Full Name
Mother's Hebrew Name (Hebrew Spelling Please)
Mother's Place of Birth
Mailing Title (please check one)
Rebbetzin
Mrs.
Dr.
Cell Number
Allow Text - To opt out reply stop at any time
Yes
No
Work #
Email
Occupation
Owner
Employee
Name of Employer
Phone Number
High School/Seminar/College Attended
Father
Father's Full Name
Father's Hebrew Name (Hebrew Spelling Please)
Father's Place of Birth
Mailing Title (please check one)
Rabbi
Mr.
Dr.
Father's Cell
Allow Text - To opt out reply stop at any time
Yes
No
Work #
Email
Occupation
Owner
Employee
Name of Employer
Phone Number
Yeshivot or Schools Attended
Grandparents
Relationship
--Select--
Paternal Grandparents
Maternal Grandparents
Last Name
Grandfather's Title
Grandfather's Name
His Cell
His Email
Grandmother's Title
Grandmother's Name
Her Cell
Her Email
Home Phone Number
Address
City
State
Zip
Relationship
--Select--
Paternal Grandparents
Maternal Grandparents
Last Name
Grandfather's Title
Grandfather's Name
His Cell
His Email
Grandmother's Title
Grandmother's Name
Her Cell
Her Email
Home Phone Number
Address
City
State
Zip
Siblings
First Name
DOB
Gender
--Select--
Male
Female
School
Add More
Is your child currently receiving any special services:
Yes
No
Please check the appropriate box:
Speech
OT
PT
Counseling
Kriah
P3
SEIT
Other
Please specify
Does your child have an IEP?
Yes
No
Please Attach
Choose file
Will your child be in need of receiving any services during the next year?
Yes
No
Where do you spend the summer?
Which summer camp does your child attend?
Any serious illness?
Yes
No
Please specify
Any physical handicap?
Yes
No
Please specify
Any allergies?
Yes
No
Please specify and how severe.
Does your child take any medication?
Yes
No
Please specify
Family Pediactrician
Pediactrician's Phone Number:
I hereby certify that the information given in this application is completed and true.
Signature of Father:
Signature of Mother:
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