Register

We will contact you after you register to provide you with more information about the school, class options, and schedules.

Student's Name*
First Last
Student's Date of Birth*
Student's Gender*
- Male
- Female
Student's Hebrew Name
Student's Email Address*
Student's Current School Name
Student's Current Grade
Student's Bar/Bat Mitzvah Date
(where applicable)
Parent/Guardian Information
Parent/Guardian #1 - Name*
Parent/Guardian #2 - Name
Parent/Guardian #1 - Relationship to Student*
Parent/Guardian #2 - Relationship to Student
Parent/Guardian #1 - Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Parent/Guardian #2 - Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Parent/Guardian #1 - Work Phone
Parent/Guardian #2 - Work Phone
Parent/Guardian #1 - Home Phone
Parent/Guardian #2 - Home Phone
Parent/Guardian #1 - Cell Phone
Parent/Guardian #2 - Cell Phone
Parent/Guardian #1 - Email*
Parent/Guardian #2 - Email
School Directory
May we share your email address with other parents in our family directory?
- Yes, you can list the email address(es) in the directory
Parent/Guardian #1 - Occupation and Employer
Parent/Guardian #2 - Occupation and Employer
Parent/Guardian #1 - Synagogue Affiliation
Parent/Guardian #2 - Synagogue Affiliation
Family Information
Siblings:
Sibling Name Age Current School
Please describe your child's strengths, challenges, and interests:
Please describe your family's - and child's - Jewish involvement and experiences:
Does your child have any allergies or other conditions we should know about?
- Yes
- No
If yes, please describe:
Please let us know any additional information that would help us provide the best possible educational experience for your student (such as an IEP).
Photo Publication Policy
We wold 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.
- Please check here if you are interested in learning about our tuition assistance program.
Parent/Guardian Signature*
CAPTCHA

Sibling Name	Age	Current School

Register

Parent/Guardian Information

Family Information

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