Religious School Enrollment 2018-2019
This form is to register a new child for the Temple Am Echad Religious School for 5779 (2018-2019 academic year).
Parent 1 Information
Parent 1 First Name *
Your answer
Parent 1 Last Name *
Your answer
Parent 1 Hebrew Name
Your answer
Parent 1 Address *
Your answer
Parent 1 City *
Your answer
Parent 1 Zip Code *
Your answer
Parent 1 E-mail Address *
Your answer
Parent 1 Home Phone *
Please enter using the following format: xxx-xxx-xxxx
Your answer
Parent 1 Cell Phone *
Please enter using the following format: xxx-xxx-xxxx
Your answer
Parent 2 Information
Parent 2 First Name *
Your answer
Parent 2 Last Name *
Your answer
Parent 2 Hebrew Name
Your answer
Parent 2 E-mail Address *
Your answer
Parent 2 Cell Phone *
Please enter using the following format: xxx-xxx-xxxx
Your answer
Does the student reside full time with both parents above? *
Emergency Contact Information
Emergency Contact 1 Name *
Your answer
Emergency Contact 1 Relationship to Student *
Your answer
Emergency Contact 1 Phone *
Please enter using the following format: xxx-xxx-xxxx
Your answer
Emergency Contact 2 Name *
Your answer
Emergency Contact 2 Relationship to Student *
Your answer
Emergency Contact 2 Phone *
Please enter using the following format: xxx-xxx-xxxx
Your answer
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