Student Information
How many children will be enrolling?
1
2
3
4
Student 1
Name
First Name
Last Name
Nickname
Preferred Pronoun
Hebrew Name
Date of birth
/
Month
/
Day
Year
Date
Age
School District
Grade
Jewish experience, Please describe what knowledge your child has of Judaism Have they had any schooling? Do they know any hebrew? Do they celebrate any of the holidays or sabbath?
Interests: Please describe what your child enjoys
Please describe what strengths you feel your child has and if you have any concerns
Student 2
Name
Frist Name
Last Name
Nickname
Preferred Pronoun
Hebrew Name
Date of birth
/
Month
/
Day
Year
Date
Age
Allergies or other medical issues
School District
Grade
Jewish experience, Please describe what knowledge your child has of Judaism. Have they had any schooling, do they know any hebrew? Do they celebrate any of the holidays or sabbath?
Interests: Please describe what your child enjoys
Please describe what strengths you feel your child has and if you have any concerns
Student 3
Name
First Name
Last Name
Nickname
Preferred Pronoun
Hebrew Name
medical issues
District
Jewish experience, Please describe what knowledge your child has of Judaism Have they had any schooling, do they know any hebrew? Do they celebrate any of the holidays or sabbath?
Interests: Please describe what your child enjoys
Please describe what strengths you feel your child has and if you have any concerns
Student 4
Name
First Name
Last Name
Nickname
Preferred Pronoun
Hebrew Name
Date of birth
/
Month
/
Day
Year
Date
Allergies or other medical issues
School District
Grade
Jewish experience, Please describe what knowledge your child has of Judaism. Have they had any schooling, do they know any hebrew? Do they celebrate any of the holidays or sabbath?
Interests: Please describe what your child enjoys
Please describe what strengths you feel your child has and if you have any concerns
PARENT/GUARDIAN INFORMATION:
Parent/ Guardian 1
Name
First Name
Last Name
Jewish?
Yes
No
Hebrew Name (If applicable)
Address
Cell Phone Number
Home Number
Email Address
example@example.com
Occupation
Willing to volunteer (The Education committee...etc)
Yes, I'm interested
No
In what capacity?
Teaching
Subbing
Helping with festivals
Becoming a member of the education
Parent/ Guardian 2
Name
First Name
Last Name
Jewish?
Yes
No
Hebrew Name (if applicable)
Address
Cell Phone Number
Home Number
Email Address
example@example.com
Occupation
Willing to volunteer (The Education committee...etc)
Yes, I'm interested
No
In what capacity?
Teaching
Subbing
Helping with festivals
Becoming a member of the education
If you can not be reached, please share your alternate emergency contact
Name
First Name
Last Name
Phone Number
Please enter a valid phone number.
Please share with us anything else you would like us to know
Submit
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