Tenafly Chabad Academy New Student Application 2021-22

TCA New Student Application

2021-2022
Welcome to Tenafly Chabad Academy.

We look forward to reviewing your application and speaking with you soon.
STUDENT INFORMATION
Last Name *
First Name *
Middle Name
Recent Photo (jpg, jpeg, png) *

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Hebrew Name *
Likes to be called
DOB

Month Day Year
Hebrew Birthdate *
(please use this Hebrew Birthdate calculator: https://www.hebcal.com/converter/ )
Birthplace *
Grade Entering, Select your Choice Below *
Child's Gender *

Female Male
Address *
Address 2
City *
State *
Zip code *
Home Phone Number *

Area Code Phone Number
Primary Email *
example@example.com
FAMILY INFORMATION
Marital Status *

Married Divorced Widowed
Please check special family circumstances: *

None Stepfather Stepmother Adopted Converted Converted Mother Converted Father Non-Jewish Father Non-Jewish Mother
If applicable, please attach court order custody agreement

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If applicable, please upload conversion certificate

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Mother/Guardian 1
Title *
First Name *
Last Name *
Maiden Name
Hebrew Name *
Cell Phone *
E-mail *
Occupation *
Employer *
Business Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Work Phone *

Area Code Phone Number
Father/Guardian 2
Title *
First Name *
Last Name *
Hebrew Name *
Cell Phone *
E-mail *
Occupation *
Employer/Business *
Business Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Work Phone

Area Code Phone Number
Additional Guardian Information (If different from parent's)
Title
First Name
Last Name
Relationship to Child
Home Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
E-mail
Cell Phone

Area Code Phone Number
Work Phone

Area Code Phone Number
Photo Permission I hereby grant permission for photography and videography of my child’s activities at the school or any activities related to the school for public relations purposes (social media). I agree that I am to receive no compensation for my child’s appearance and that this participation confers on me no ownership rights whatsoever. (Please mark yes or no) *

Yes No
Trip Permission I give permission for my child to participate in walking trips within the school’s neighborhood. *

Yes No
Synagogue Affiliation
Name of the Synagogue, City & State *
Name of the Rabbi *
Siblings:
Sibling #1 Name (or just write "none) *
DOB

Month Day Year
Current School (or just write "none) *
Has this child ever attended LPS or TCA?

Yes No
Sibling #2 Name (or just write "none) *
DOB

Month Day Year
Current School (or just write "none) *
Has this child ever attended LPS or TCA?

Yes No
Sibling #3 Name (or just write "none) *
DOB:

Month Day Year
Date
Current School (or just write "none) *
Has this child ever attended LPS or TCA?

Yes No
Grandparent Information:
Paternal Grandparent Names
Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Phone Number

Area Code Phone Number
Email
example@example.com
Maternal Grandparent Names
Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Phone Number

Area Code Phone Number
Email
example@example.com
Emergency Contacts other than Parents:
Emergency Contact #1
Name *

First Name Last Name
Relationship *
Phone *

Area Code Phone Number
Cell *

Area Code Phone Number
Emergency Contact #2
Name *

First Name Last Name
Relationship *
Phone *

Area Code Phone Number
Cell *

Area Code Phone Number
About Your Child:
Please share some of your child's strengths, interests,unique talents and abilities. Please share any factors that may have impacted your child's academic, developmental and social progress to date: *
Has your child ever received any evaluations or ongoing services: i/e speech and language, occupational, physical, psychological or education therapy *

Yes No
If Yes, please describe below
Please attach your child's two most recent report cards, IEP (if applicable) and any other paperwork you will have relating to the development of your child. This is required for all transfering students:
Attachment: *

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Attachment: *

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Attachment:

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Attachment:

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Please select the words that describe your child: *

Anxious Responsible Creative Cautious Assertive Independent Natural Leader Motivated Confident Distractible Follower Reserved Strong Willed Happy Needs clear boundaries Perfectionist Articulate Energetic Emotionally Aware
Current School: *
Dates Attended *
School Phone Number *

Area Code Phone Number
Principal/Director *
Email *
example@example.com
I authorize the administrators of TCA Academy to communicate directly with personnel in my child's current school and non-school professionals to obtain information about his/her social, emotional, and academic development. This may include written and verbal recommendations, evaluations, copies of reports, official transcripts, standardized test results, school visits and observations. I understand and acknowledge that this information will not be made available to me. I also consent to having TCA contact other professionals related to my child's *

Authorize
Students must receive all immunizations as required by New Jersey State law and the American Academy of pediatrics in order to be admitted to school. Please submit an immunization record with your application. *

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By signing and submitting this form, I attest that the above information is all correct.
Signature of Parent 1: *
Please type your name
Date *

Month Day Year
Signature of Parent 2:
Please type your name
Today's Date

Month Day Year
Date
Thank you for considering Tenafly Chabad Academy for your family. Your application will be reviewed by our admissions team and we look forward to being in touch.

Upon submitting this form, you will be directed to a payment page. There will be a $150 non-refundable, required fee that must be paid in order for the application to be considered.
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