Hebrew School Registration 2022-2023 - Form - Conservative Synagogue Adath Israel of Riverdale

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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?

* How many households does the child have?

Parent 1 Full Name:

Parent 1 Permissions:

Pick up child from Hebrew SchoolDiscuss childs school progressChoose 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 SchoolDiscuss childs school progressChoose 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 SchoolDiscuss childs school progressChoose 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 SchoolDiscuss childs school progressChoose those that are applicable.

Parent 4 Email:

Parent 4 Cell Phone:

Parent 4 Work Phone:

* Are Parents Jewish?

Parent 1Parent 2

Marital Status:

MarriedPartneredSeparatedDivorcedSingle ParentParent Deceased

If parents are not living together, is there joint custody?

YesNo

If parents are not living together, do both parents wish to be kept informed?

YesNo

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.

Wed, August 10 2022 13 Av 5782

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