2016-2017 Religious & Hebrew School Registration Form
Student 1 - First Name
Student 1 - Last Name
Student 1 - Birthdate
Student 1 - Gender
Student 1 - Hebrew Name
Transliteration - ex. Yosef
Student 1 - Name of Public School attending in 2016-2017
Student 1 - Grade in Public School in 2016-2017
Student 1 - Grade & Day in Religious School in 2016-2017
Gan Sunday, 9:30-11:30am
Kindergarten Sunday, 9:30-11:30am
1st grade Sunday, 9:30-11:30am
2nd grade Sunday, 9:30-11:30am
3rd grade Sunday, 9:30-11:30am
4th grade Sunday, 9:30-11:30am
5th grade Sunday, 9:30-11:30am
6th grade Sunday, 9:30-11:30am
7th grade (select and go to next question)
8th grade Monday, 6:30-8:30pm
9th grade Monday, 6:30-8:30pm
10th grade Monday, 6:30-8:30pm
11th grade Monday, 6:30-8:30pm
12th grade Monday, 6:30-8:30pm
Student 1 - Grade & Day in Hebrew School in 2016-2017
Aleph Monday, 4:30-6:00pm
Aleph Wednesday, 4:30-6:00pm
Bet Monday, 4:30-6:00pm
Bet Wednesday, 4:30-6:00pm
Gimel Monday, 4:30-6:00pm
Gimel Wednesday, 4:30-6:00pm
Daled Monday, 4:30-6:00pm
Daled Wednesday, 4:30-6:00pm
7th grade & Hey Wednesday, 4:30-6:00pm
Does your child have medical restrictions?
Physician's Phone Number
What are some of your child's hobbies and interests?
What is your child's favorite thing about being Jewish? (holiday, story, food, song, prayer, etc)
How does your child learn best? (ex. visual auditory, kinesthetic, work well in a quiet space, prefer sitting up front, etc,)
Tell us about your child as a learner: Strengths
Please list your child's strengths as a learner
Tell us about your child as a learner: Challenges
Please list your child's challenges as a learner
If your child is currently receiving special services in public school, please mark below:
LD self contained
LD self contained
If you answered yes that this child is recieving services in public school. Please tell us how your child is impacted and supported in a learning enviroment?
Which of the following medical conditions apply to your child? (Choose all that apply)
List any Allergies for this child
List any Medical Conditions that have not been noted yet
Is there anything special we should do if the above problem arises?
Does your child take any medication?
Please list medications taken by your child
Is your child afraid of loud noises?
Is your child afraid of flashing lights?
Is there anything else you would like to share about your child?
Are there any students your child should NOT be placed with?
Please write the name(s) here
Additional Student to Register
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