2019-20 Kesher Hebrew School Registration Form
Last Name *
Your answer
First Name of Student *
Your answer
Gender
Age *
Your answer
Birthdate *
Include approximate time of day, and we can tell you your child's Hebrew birthday!
Your answer
Address *
Your answer
City *
Your answer
State *
Your answer
Zip Code *
Your answer
Home Phone Number *
Your answer
Father's Mobile Phone Number *
Your answer
Mother's Mobile Phone Number *
Your answer
Father's E-mail
Your answer
Mother's E-mail *
Your answer
Emergency Contact *
Your answer
Relation
Relation of emergency contact to you.
Your answer
Emergency Contact Phone Number *
Your answer
Student's Hebrew Name *
Your answer
Mother's Hebrew Name *
Your answer
Father's Hebrew Name *
Your answer
Synagogue Affiliation *
(if any)
Your answer
School Attending *
Your answer
Grade *
Your answer
Level of Hebrew Reading Fluency *
Level of Hebrew Speaking Fluency
Judaic Studies Background
List any prior Judaic learning year child has done.
Your answer
Please share any goals you have for your child attending Kesher.
Your answer
If Kesher offered more than one day per week would you be interested
There would be an extra tuition cost for the second day.
Check below if you can volunteer to help Kesher
Please choose one or more ways you can be of help
Any medical conditions or allergies? *
Your answer
How did you hear about Kesher?
Your answer
Would you like to donate to our scholarship fund?
I agree to the following liability release *
On behalf of myself, my heirs, executors, administrators, and assigns hereby RELEASE, DISCHARGE, WAIVE AND RELINQUISH any and all claims, known or unknown, including, but not limited to claims of negligence, or causes of action for personal injury, property damage or wrongful death, arising from my participation in Kesher Hebrew School at HILLEL’s facilities, or any activities incidental thereto, against HILLEL HEBREW ACADEMY and its representatives, including, without limitation, all parent, subsidiary, and affiliated organizations, its respective agents, employees, servants, directors officers, attorneys, assigns and successors, and each of them. I understand that by my or my children's participation I consent to be photographed or video taped for use in promotion of Kesher Hebrew School's activities.
Required
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service