Hebrew Online School


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Bar Mitzvah Cheder Division

REGISTRATION FORM
General Information
Where did you hear about us
Student's Information
Son's First Name *
Last Name *
Gender *	Male Female
Birth Date (MM/DD/YYYY) *
Approximate time of day when born and location of birth
Son'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 school is your son currently attending? *
Phone number for your son's current school? *
What are you hoping your son will gain in this class? *
Which days of the week would work best for your son? Please include all possible days *
Which times would work best? Please include all possible hours. *
I am also only/also interested in Bar Mitzvah tutoring? *
Would you also be interested in our daily or weekly Cheder classes? *
* = Required Fields