Kesher 2021-22 Class Registration
If you have more then one student in your family, you will be asked to fill out the information for your other student(s) later in this form.

Please contact Rabbi NB with any comments or questions at enemitoffbresler@tiwestport.org.
Student #1 Name *
Student #1 School
If you answered "other" above please write the name of the school.
If you answered "other" above please write the name of the school.
Student #1 Date of Birth *
MM
/
DD
/
YYYY
Student #1 Gender Identity *
Parent/ Guardian #1 Name *
Parent/ Guardian #1 Phone Number *
Parent/ Guardian #1 Email *
Parent/ Guardian #2 Name
Parent/ Guardian #2 Phone Number
Parent/ Guardian #2 Email
Student #1 2021-22 Grade *
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