Application/Registration Form 2018-2019
WEST HILLS HEBREW SCHOOL
PLEASE NOTE: IF YOUR ARE NOT CURRENTLY IN OUR PROGRAM THIS FORM WILL SERVE AS AN APPLICATION FORM
Please fill out one form per child attending

Student Information
Student's Name *
Your answer
Last Name *
Your answer
Hebrew Name
Your answer
Date Of Birth *
Your answer
Hebrew Birthday
Your answer
Grade Entering in September 2018 *
Is this student's first year at West Hills Hebrew School *
Required
Address *
Your answer
City *
Your answer
Zip *
Your answer
Home Phone *
Your answer
School Attending *
Your answer
What day would you like to join.
First Preference
Please let us know if another day and time would work better for you.
Your answer
Friend Request 1
Your answer
Friend Request 2
Your answer
FIRST YEAR STUDENTS ONLY. Does your child have any previous Jewish education?
Your answer
Bar/Bat Mitzvah Date
Your answer
Start of Bar/Bat Mitzvah Training
8 to 12 month prior to ceremony (Coordinate with the rabbi)
Your answer
Parent Information
Mother's First & Last Name *
Your answer
Hebrew Name
Your answer
Cell Phone *
Your answer
Email *
Your answer
Occupation
Your answer
Work Phone
Your answer
Father's First and Last Name *
Your answer
Hebrew Name
Your answer
Cell Phone *
Your answer
Email *
Your answer
Occupation
Your answer
Work Phone
Your answer
Is biological mother of the child Jewish by birth? *
Required
Any conversions in the family
Your answer
Is biological father of the child Jewish by birth? *
Required
Comment
Your answer
Emergency Information
Emergency Contact (NOT living with you) *
Your answer
Relation *
Your answer
Home Phone *
Your answer
Cell Phone *
Your answer
Work Phone
Your answer
Doctor *
Your answer
Phone *
Your answer
Address *
Your answer
City *
Your answer
Zip *
Your answer
Allergies or other Medical Condition
Your answer
Sibling Information (Not attending West Hills Hebrew School)
Name
Your answer
Last Name
Your answer
Hebrew Name
Your answer
Date of Birth
Your answer
School Attending
Your answer
Grade Entering in September 2018
Your answer
Does your child have any previous Jewish education
Your answer
Other Children at Home
Name
Your answer
Date of Birth
Your answer
Hebrew Name
Your answer
Date of Birth
Your answer
School Attending
Your answer
Grade Entering in September 2018
Your answer
Does your child have any previous Jewish education
Your answer
How did you hear about us?
Your answer
Referred by
Your answer
Would you like to attend our High Holiday services?
May we post pictures of our school and programs that include your chidlren. Please let me know if you prefer not.
Your answer
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