Jewish Learning Center at Congregation B'nai Sholom - Beth David Registration Form 2019-2020 School Year.
The Jewish Learning Center is a premier educational institution offering Judaic and Hebrew Language courses for students from 3 years of age until 7th grade. Please complete the following registration form to register for the 2019-2020 academic school year. Any questions please contact Principal Dan at 516-286-8308 or dseid9@gmail.com. School begins on Sunday September 8, 2019.
Email address *
Mother Full Name
Your answer
Mother Cell Phone Number
Your answer
Mother E-mail Address
Your answer
Father Full Name
Your answer
Father Cell Phone Number
Your answer
Father E-mail
Your answer
Emergency Contact Name other than Parent/Guardian *
Your answer
Emergency Contact Number other than Parent/Guardian *
Your answer
Child One Full Name *
Your answer
Child One Hebrew Name (Phonetic spelling as best you can is fine) Please skip if unknown.
Your answer
Child One Grade in September 2019 *
Name of Public or Private Day School Child One will attend in September, 2019? *
Your answer
Child One Date of Birth *
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Child One Allergy/Medical Information
Your answer
Child One special needs/information you want us to be aware of?
Your answer
Child Two Full Name
Your answer
Child Two Hebrew Name (Phonetic spelling as best you can is fine) Please skip if unknown.
Your answer
Child Two Grade Level in September 2019
Name of Public or Private Day School Child Two will attend in September, 2019?
Your answer
Child Two Date of Birth
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DD
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YYYY
Child Two Allergy/Medical Information
Your answer
Child Two special needs/information you want us to be aware of?
Your answer
Child Three Full Name
Your answer
Child Three Hebrew Name (Phonetic spelling as best you can is fine) Please skip if unknown.
Your answer
Child Three Grade in September 2019
Name of Public or Private Day School Child Three will attend in September, 2019?
Your answer
Child Three Date of Birth
MM
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DD
/
YYYY
Child Three Allergies/Medical Information?
Your answer
Child Three Special Needs/Information you want us to be aware of?
Your answer
For any child 4th grade and up, please let us know of an estimated bar/bat mitzvah date? This is for planning purposes, please confirm all dates with the Rabbi.
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DD
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I/we give permission to photograph our children for JLC publications and advertisements. *
Membership Acknowledgement *
JLC Fees Acknowledgement *
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