Tenafly Chabad Academy New Student Application 2022-23

TCA New Student Application

2022-2023
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

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

FemaleMale
Address*
Address 2
City*
State*
Zip code*
Home Phone Number*

Area CodePhone Number
Primary Email*
example@example.com
Current School*
Please fill out this form if your child attended a private school
If applying from a private school please complete the following form

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FAMILY INFORMATION
Marital Status*

MarriedDivorcedWidowed
Please check special family circumstances:*

NoneStepfatherStepmotherAdoptedConvertedConverted MotherConverted FatherNon-Jewish FatherNon-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

CityState / Province

Postal / Zip Code
Work Phone*

Area CodePhone 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

CityState / Province

Postal / Zip Code
Work Phone

Area CodePhone 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

CityState / Province

Postal / Zip Code
E-mail
Cell Phone

Area CodePhone Number
Work Phone

Area CodePhone 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)*

YesNo
Trip Permission I give permission for my child to participate in walking trips within the school’s neighborhood.*

YesNo
Synagogue Affiliation
Name of the Synagogue, City & State*
Name of the Rabbi*
Siblings:
Sibling #1 Name (or just write "none)*
DOB

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

YesNo
Sibling #2 Name (or just write "none)*
DOB

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

YesNo
Sibling #3 Name (or just write "none)*
DOB:

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

YesNo
Grandparent Information:
Paternal Grandparent Names
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number

Area CodePhone Number
Email
example@example.com
Maternal Grandparent Names
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number

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

First NameLast Name
Relationship*
Phone *

Area CodePhone Number
Cell*

Area CodePhone Number
Emergency Contact #2
Name*

First NameLast Name
Relationship*
Phone *

Area CodePhone Number
Cell*

Area CodePhone 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*

YesNo
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:*

AnxiousResponsibleCreativeCautiousAssertiveIndependentNatural LeaderMotivatedConfidentDistractibleFollowerReservedStrong WilledHappyNeeds clear boundariesPerfectionistArticulateEnergeticEmotionally Aware
Current School:*
Dates Attended*
School Phone Number*

Area CodePhone 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*

MonthDayYear
Signature of Parent 2:
Please type your name
Today's Date

MonthDayYear
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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