NACHAS 2015-2016 Registration Form
Please help us easily organize registration information and create class rolls by using our online form to register your student(s). Note: if you have more than one student to register, just fill out the entire form ONCE. Then use a new form to fill in just the required information. We'll pull the rest into the spreadsheet for you.
Student Information
Student's First Name *
Your answer
Student's Last Name *
Your answer
Student's Hebrew Name
Your answer
Gender *
Grade in School *
Your answer
Birthdate *
MM
/
DD
/
YYYY
Street Address *
Your answer
City *
Your answer
ZIP Code *
Your answer
Parent Information
Parent #1 Name (First & Last) *
Your answer
Parent #1 Primary Phone # *
Your answer
Parent #1 Alternate Phone #
Your answer
Parent #1 Email Address
Your answer
Parent #2 Name (First & Last)
Your answer
Parent #2 Primary Phone #
Your answer
Parent #2 Alternate Phone #
Your answer
Parent #2 Email Address
Your answer
Which parent should we use as the primary contact for school matters?
Emergency Contact Information
We'll contact this person if we can't get in touch with parents.
Contact Name (First & Last)
Your answer
Contact Primary Phone #
Your answer
Secondary Phone #
Your answer
Relationship to Student
Your answer
Your answer
Does the student have any food allergies or health issues we should know about?
If so, please provide information in the text box. It will help us prepare snacks that all students can enjoy & stay safe.
Your answer
Submit
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