Midrasha Returning Student Enrollment

This registration form is for students in grades 8-12 that are already enrolled in Midrasha/ MOJU. If you would like to enroll a new student in Midrasha click here.

Student Name

Please list the student that you are completing this re-enrollment for

First Last

Confirm enrollment information(Required)

This refers to the enrolment information we currently have on record. A copy of this information was emailed to you in the first week of August.

The information is correct and there are no changes necessary

I need to update the enrollment information

Update enrollment information

Only complete the fields that you need to update for the current school year.

Student's Name

First Last

Student's Date of Birth

Student's Pronouns

he/him

she/her

they/them

Other

Student's Hebrew Name

Student's Email

Student's Cell Phone

Student's Current School

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:

Additional Information or Accomodations

Please let us know any additional information about your student that would help us provide the best possible educational experience (such as an IEP).

Parent Guardian #1

Name

First Last

Relationship to Student

Address

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

Cell Phone

Parent Guardian #2

Name

First Last

Relationship to Student

Address

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

Cell Phone

Hidden

Section Break

Parent/Guardian Signature(Required)

Parent/Guardian Email(Required)

For confirmation of form submission

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