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Register New Student 2024-2025

STUDENT INFORMATION
Full Name*
First Name Last Name
Hebrew Name
Gender*
Birthdate *
Grade Entering*

Address*

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Additional Notable Information: Please let us know if there are any allergies or other important information we need to be aware of.*
Birth Certificate*
Reference Letter From Your Child's Previous School, If Applicable
PARENTS INFORMATION
Father's Name*
First Name Last Name
Father's Cell Number*
Father's E-mail*
Occupation*
Business Phone Number*
Is Father Jewish?*

YesNo
Father Jewish by?

BirthChoice
Father's Government Issued Photo ID*
Mother's Name*
First Name Last Name
Mother's Cell Number*
Mother's E-mail*
Occupation
Business Phone Number
Is Mother Jewish*

YesNo
Mother Jewish by

BirthChoice
Marital Status*

MarriedSeparatedDivorced
Mother's Government Issued Photo ID*
Language Spoken at Home
Name and Ages of Siblings
Placement of Child in Family
MEDICAL AND EMERGENCY INFORMATION
Emergency Alternate Contacts
Full Name*
First Name Last Name
Relationship to Child*
Phone Number*
Full Name*
First Name Last Name
Relationship to Child*
Phone Number*
AUTHORIZATION FOR PICK UP
I authorize the following people to pick my child up from school without prior notice.
Full Name*
First Name Last Name
Relationship to Child*
Please attach a photo id for the person listed above.*
Full Name*
First Name Last Name
Relationship to Child*
Please attach a photo id for the person listed above.*
Circumstances may occur when you will need someone that is not listed above to pick your child up from this facility. When these circumstances arise, you will call and inform us of your instruction. Informing us of your password will enable us to carry out your instructions.
Password*
Doctor's Information
Doctor's Name*
Doctors Office Number*

Address*

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Medical Problems?*
Medical and Immunization Forms*
Emergency Care Authorization
In case of a medical emergency requiring immediate emergency care, I give consent to transport my child by ambulance to the nearest hospital and administer the appropriate care.*

YesNo
Primary Insurance Provider
Policy Number
Expiration Date
PAYMENT
Registration Fee *

$450.00
*The registration fee is non-refundable and is not applied to tuition.
Total

$450.00

Payment*

Credit Card

We accept Visa, MasterCard, American Express, Discover
Credit Card Number	Security Code
Name on Card
Expiration Month	Expiration Year

Billing Address

Street Address

City

State / Province

Postal / Zip Code

Country

Please Note, Submission of this application does not imply automatic acceptance. The next step in the admission process involves a scheduled interview, which will play a crucial role in determining acceptance. We will contact you to arrange the interview at a convenient time.
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STUDENT INFORMATION

PARENTS INFORMATION

MEDICAL AND EMERGENCY INFORMATION

Emergency Alternate Contacts

AUTHORIZATION FOR PICK UP

I authorize the following people to pick my child up from school without prior notice.

Circumstances may occur when you will need someone that is not listed above to pick your child up from this facility. When these circumstances arise, you will call and inform us of your instruction. Informing us of your password will enable us to carry out your instructions.

Doctor's Information

Emergency Care Authorization

PAYMENT

*The registration fee is non-refundable and is not applied to tuition.

Please Note, Submission of this application does not imply automatic acceptance. The next step in the admission process involves a scheduled interview, which will play a crucial role in determining acceptance. We will contact you to arrange the interview at a convenient time.