Hebrew School Registration 2019-2020

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* Student Name:

* Age:

* Birthdate:

* Address:

* Zipcode:

Hebrew Name:

Secular School:

School Phone:

* Grade as of Sept. 2019:

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?

MotherFather

* Marital Status:

MarriedSeparatedDivorcedSingle 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:

Where 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, September 18 2019 18 Elul 5779

CSAIR :: 475 West 250th Street :: Bronx, NY 10471 :: 718-543-8400 :: info@csair.org

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