J School Student Registration 2018-2019/5778-5779

Completed forms can be submitted at the end of this registration process. Checks or CC information can be sent to and paid to the order of:
Congregation Ner Shalom
85 La Plaza
Cotati, CA 94931.

For questions, please call Mia Cohen 707-326-7853 or Leslee Lauritzen 707-477-5212, or e-mail at school@bnaiisrael.net.

Please complete one form for each child. Any duplicate information does not need to be repeated (medical, dental, parent contact information, etc.)

Student Name *
First and Last
Your answer
Congregation Membership at *
Secular School
Your answer
Contact Information
IF YOUR STUDENT IS A RETURNING STUDENT, ONLY COMPLETE INFORMATION THAT HAS CHANGED ON THE CONTACT INFORMATION.
Grade (2018-2019)
Your answer
Date of Birth
MM
/
DD
/
YYYY
Address
Street, City, Zip
Your answer
Home Phone
Your answer
Cell Phone
Your answer
Email
Your answer
Parent 1 Name
Your answer
Parent 1
Cell Phone
Your answer
Business/Daytime Phone
Your answer
Email
Your answer
Occupation
Your answer
Parent 2
Name
Your answer
Cell Phone
Your answer
Business/Day Phone
Your answer
Email
Your answer
Occupation
Your answer
Additional Adult with Parental Authority
Name
Your answer
Cell Phone
Your answer
Business/Daytime Phone
Your answer
Email
Your answer
Occupation
Your answer
Grandparents
We would like to be able to contact your children's grandparents, to share information about J School, to fundraise and to invite them occasionally to school.
May we contact them with a fundraising letter?
Grandparent Name(s)
Your answer
Street Address, City, State and Zip
Your answer
Email
Your answer
Grandparent Name(s)
Your answer
Street Address, City, State, Zip
Your answer
Email
Your answer
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