Midrasha New Student Enrollment

This registration form is for NEW students in grades 8-12 enrolling in Midrasha/ MOJU. If you would like to re-enroll a returning student click here.

Student's Name*

First Last

Student's Date of Birth*

Student's Pronouns*

he/him
she/her
they/them

Student's Hebrew Name

Student's Email Address*

Student's Cell Phone*

Student's Current School Name*

Student's Current Grade*

Synagogue Affiliation

Parent/Guardian Information

Parent Guardian #1

Name*

First Last

Relationship to Student*

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Cell Phone

Email*

Parent Guardian #2

Name

First Last

Relationship to Student

Address

Same as Parent/Guardian #1

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Cell Phone

Email

Family Information

Siblings:

Sibling Name	Age	Current School

Is there any additional information the teacher should know about your student or family?

Hidden

Section Break

Photo Publication Policy

We would like to use photos of our students in newsletters and on the webpage. Students featured in the pictures will not be identified by name without prior permission from the parent. Please check below that you are in agreement with this policy. If you are not in full agreement, please list any restrictions.

I authorize the use of my student's photograph without name identification in school publications and promotional materials without compensation or further authorization.

Photo Publication Policy - Comments/Restrictions:

Tuition Assistance

Limited tuition assistance is available for families who demonstrate a need and meet our qualifications.

Please check here if you are interested in learning about our tuition assistance program.

Parent/Guardian Signature*

Would you like to enroll another student?*

Yes
No

Student 2 Registration

Student's Name*

First Last

Student's Date of Birth*

Student's Pronouns*

he/him
she/her
they/them

Student's Hebrew Name

Student's Email*

Student's Cell Phone*

Student's Current School Name*

Student's Current Grade*

Is there any additional information the teacher should know about your student or family?

Photo Publication Policy

We would like to use photos of our students in newsletters and on the webpage. Students featured in the pictures will not be identified by name without prior permission from the parent. Please check below that you are in agreement with this policy. If you are not in full agreement, please list any restrictions.

I authorize the use of my student's photograph without name identification in school publications and promotional materials without compensation or further authorization.

Photo Publication Policy - Comments/Restrictions:

CAPTCHA