TBA Religious School Registration 2019-2020
Email address *
Student Name *
Your answer
Grade *
Required
Hebrew Name
Your answer
Birthdate *
MM
/
DD
/
YYYY
Parent 1 Name *
Your answer
Preferred Parent Email *
Your answer
Preferred Parent 1 Contact Number *
Your answer
Parent 1 Address *
Your answer
Parent 2 Name
Your answer
Parent 2 Email
Your answer
Parent 2 Contact Number
Your answer
Parent 2 Address (if different than Parent 1)
Your answer
Child resides with *
Required
Public School *
Your answer
Siblings/Ages (in and out of school) *
Your answer
Local Emergency Contact #1 (Name and Number) *
Your answer
Local Emergency Contact #2 (Name and Number) *
Your answer
The following people are authorized to to pick up my child from religious school...
Your answer
My child has the following medical/other needs which may require medications or cause behavior changes. Please describe and give necessary support information.
Your answer
Insurance Information (Name of Policy and Insured's Name) *
Your answer
Financial Obligation *
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