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Hebrew School Registration 2022-2023
Please verify reCaptcha before submitting the form.
*
Student Name:
*
Age:
*
Birthdate:
*
Address:
*
Zipcode:
Hebrew Name:
*
Secular School:
*
School Phone:
*
Grade as of Sept. 2022:
Name/age(s) os siblings:
*
How many parents/guardians does the child have?
Please Select One
One Parent/Guardian
Two Parents/Guardian
Three Parents/Guardian
Four Parents/Guardian
*
How many households does the child have?
Please Select One
One Household
Two Households
Three Households
Four Households
Parent 1 Full Name:
Parent 1 Permissions:
Pick up child from Hebrew School
Discuss childs school progress
Choose those that are applicable.
Parent 1 Email:
Parent 1 Cell Phone:
Parent 1 Work Phone:
Parent 2 Full Name:
Parent 2 Permissions:
Pick up child from Hebrew School
Discuss childs school progress
Choose those that are applicable.
Parent 2 Email:
Parent 2 Cell Phone:
Parent 2 Work Phone:
Parent 3 Full Name:
Parent 3 Permssions:
Pick up child from Hebrew School
Discuss childs school progress
Choose those that are applicable.
Parent 3 Email:
Parent 3 Cell Phone:
Parent 3 Work Phone:
Parent 4 Full Name:
Parent 4 Permissions:
Pick up child from Hebrew School
Discuss childs school progress
Choose those that are applicable.
Parent 4 Email:
Parent 4 Cell Phone:
Parent 4 Work Phone:
*
Are Parents Jewish?
Parent 1
Parent 2
Marital Status:
Married
Partnered
Separated
Divorced
Single Parent
Parent Deceased
If parents are not living together, is there joint custody?
Yes
No
If parents are not living together, do both parents wish to be kept informed?
Yes
No
If so, list name, address and phone number:
Were you referred to the Marsha Dane Hebrew School?
If yes, who referred you?
Name of Previous Religious School if New Student:
New Students Only
# of Years Attended:
New Students Only
Number of days/week:
New Students Only
Proof of immunization required for enrollment. Please send a copy to
Education Director, Mason Voit
.
Sun, May 11 2025 13 Iyyar 5785
