2018-2019 Student Registration
Religious School Information Form
For returning students, only new/changed information must be filled out. Please review the form you received in the mail and enter any changes here.
Email address *
Student Information
Last Name *
Your answer
First Name *
Your answer
Gender
Date of Birth
MM
/
DD
/
YYYY
Age
Your answer
Street Address
Your answer
City
Your answer
State
Your answer
Zip
Your answer
Home Phone
Your answer
Child's Cell Phone
Your answer
Student Email (to receive class information)
Your answer
Child's Hebrew Name
Your answer
Religious School Grade in August *
Public School Grade in August
Name of Weekday School
Your answer
Does student have any special needs that might affect his/her learning experience in religious school (medical, learning disabilities, emotional issues, family issues, etc.)? Please specify.
Your answer
Would you like to be contacted by our Special Needs/Inclusion Director?
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