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Cheder
 
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  *
Additional Information
Which of our Cheder classes would you be iterested in? * Weekly class
Daily class
Which school is your child currently attending? *
Phone number for your child's current school? *
What are you hoping your child will gain in this class? * 
Which days of the week would work best for your child?
Please include all possible days * 
Which times would work best?
Please include all possible hours. * 
Is there anything you would like us to know about your child? * 
* = Required Fields

     
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