Hebrew School Admission Form 2024-2025
Name
First Name
Last Name
Hebrew Name (if the student have one)
First Name
Date of Birth
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Gender
Please Select
Male
Female
Non Binary
Grade
Does the student have any health concerns our staff needs to be aware of? If YES, please elaborate Here:
Guardian #1 Name
First Name
Last Name
Guardian #1 Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Guardian #1 Email
example@example.com
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Guardian #2 Name
First Name
Last Name
Guardian #2 Email
example@example.com
Guardian #2 Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Address - Guardian #2
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
In Case of Emergency, Please call First:
Please Select
Guardian #1
Guardian #2
Emergency Contact (In case we can't reach you)
First Name
Last Name
Emergency Contact (In case we can't reach you) - Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Are You A Member of Beth Jacob Synagogue / Herman Jewish Community Center?
Yes
No
Do you acknowledge that payment for Hebrew School must be completed prior to the beginning of the school year?
Yes
No
Submit Application
Should be Empty: