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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
Additional Information about your Child
This past year, was your child? *   Homeschooled
Hebrew Day School
Public School
If your child was in Day School what school was he/she attending? *
Which years did he/she attend this school? *
Which Jewish Community are you affiliated with? *  
Why do you feel the online school would be the best fit for your child? *
Which subject/s would you like your child to learn in his class? We would like to accomodate if possible! *
Rate your Child
Where is your child holding in his/her Hebrew reading and Jewish Studies? *
Has he/she learned the Alef Bet? The Vowels? Can he/she read Hebrew? Has he/she begun learning Chumash? With Rashi? Please be as specific as possible. *
Indicate anything we need to know about your child? 
If you child is attending public school or day school what time does he/she come home from school? *
Would you be interested in our Conversational Hebrew Class? *
* = Required Fields
     
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