A division of the
Nigri International
Jewish Online School
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Conversational Hebrew Classes
 
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
To apply to this class we will give an evaluation test
to see which level to place your child in.
* = Required Fields