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Tehilas Chaya Sara
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Student Information
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First Name
Last Name
Hebrew Spelling - First Name
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Preferred Name
Applying To Grade
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Kindergarten
Primary
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Date of Birth
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School Attending This Year
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School Address
Day Camp Attended this past Summer
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Report Card
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Playgroup Attending this Year
Playgroup Number
Playgroup Address
Playgroup Attended Last Year
Playgroup Number
Playgroup Address
Allergies
Important Medical Information
Has your child recieved any special services? Please describe
Parents' Marital Status
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Married
Separated
Divorced
Father is Deceased
Mother is Deceased
Student Lives With
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Father
Mother
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Father Information
Father's Title
Father's First Name
Father's Cell Number
Father's Email Address
Father's Occupation
Father's Work Name
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Father's Work Address
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Father's Work State
Father's Work Zip
Father's Mesivta
Father's Bais Medrash
Mother Information
Mother's Title
Mother's First Name
Mother's Last Name
Maiden Name
Mother's Cell Number
Mother's Email Address
Mother's Occupation
Mother's Work Name
Mother's Work Phone Number
Mother's Work Address
Mother's Work City
Mother's Work State
Mother's Work Zip
Mother's High School
Mother's Seminary
Contact Information
Father
Home Phone Number
Neighborhood Name
Address
City
State
Zip
Shul Affiliation
Rav's Name
Rav's Number
Mother
Home Phone Number
Address
City
State
Zip
Grandparents
Relationship
Paternal 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
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
Sibling Information
First Name
Age
School / Playgroup
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Misc Information
Other Schools Applying To
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Families you know in Tehilas Chaya Sara
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References
1- Name
Number
Relationship
2- Name
Number
Relationship
Vaccinations Policy
I understand that as per Tehilas Chaya Sara acceptance policy, my child will need to be up to date with all vaccinations
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Father's Signature
Mother's Signature
Today's Date
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