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Jewish Hebrew School
 
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REGISTRATION FORM
General Information
Where did you hear about us
Student's Information
Child's First Name *
Last Name *  
Gender * Male Female
Birth Date (MM/DD/YYYY) *  
Approximate time of day when born and location of birth
Child's Current Grade *  
Is your child .... *  existing student new student
Parents Information
Father's First Name *
Mother's First Name *
Address *
City *
State *
ZIP *
Country *
Home Phone *
Father Cell *
Mother Cell *
Father's Email  *
Mother's Email  *
Father Jewish By? *  Birth Conversion Other
Mother Jewish By? *  Birth Conversion Other
Family Information
Paternal Grandfather *  Jewish Converted Other
Paternal Grandmother *  Jewish Converted Other
Maternal Grandfather *  Jewish Converted Other
Maternal Grandmother *  Jewish Converted Other
Were there any adoptions in the family? *Yes No 
Additional Information about your Child
Briefly describe your Jewish life at home.
Are you currently affiliated with a Jewish community? *
(Shul, Temple, Synagogue, JCC, other Hebrew School, Chabad, etc.)
Does your child currently receive any other Jewish education? Please elaborate. 
How many years of formal Jewish studies has your child received? Where? *
Rate your Child
Does he/she know the Hebrew alphabet? * Beginner
Intermediate
Advanced
Can your child read simple Hebrew words? * Beginner
Intermediate
Advanced
Please indicate anything you feel we need to know about your child. 
What day of the week works out  best for your child? *
What time works out best for your child? *
Would you be interested in a Conversational Hebrew class? * 
* = Required Fields