Yeshiva Tehilas Shlomo Application

Application for Zman

Applicants Name*

First NameMiddle NameLast Name

Preferred Name

Date of Birth ddmmyy*

Date

Birth Place

Israel Cell

Please enter a valid phone number.

Home Telephone

Please enter a valid phone number.

Email*

example@example.com

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Citizenship*

Passport No*

Family Information

Parents' Marital Status

Fathers Name*

Fathers Cell Phone*

Fathers Email*

example@example.com

Fathers Occupation

Mothers Name*

Mothers Maiden Name

Mothers Cell Phone*

Mothers Email*

example@example.com

Mothers Occupation

Schooling

Current School Attending*

Present Shiur Rebbe*

List Previous Schools Attended

Name of Previous Yeshiva/School From: Year To: Year

References

Who recommended Yeshiva Tehilas Shlomo to you

Please list at least 2 two references that can be contacted as necessary:

Name: Name of Reference* Relationship to you* Telephone:
(000)000-0000

Name: Name of Reference* Relationship to you* Telephone:
* (000)000-0000*

Name: Name of Reference Relationship to you Telephone:
(000)000-0000

Were you, your parents or grandparents born in - or citizens of the state of Israel?*

YesNoOther

Do you have any medical (physical/psychological) issues the Yeshiva should be aware of?*

YesNoOther

Any medical conditions that the yeshiva should be aware of

-I agree that I am responsible for arranging medical insurance, but I hereby empower the official representatives of Yeshiva Tehilas Shlomo to authorize emergency medical treatment on the advice of a physician for myself/my child.

-I agree to commit to abide by all the Yeshivas rules inc. the Tuition policy.

-I agree that I am solely responsible for safeguarding all my possessions while I am in the Yeshiva and that any left in the Yeshiva after I leave will be hefker.

Signature of applicant or if under 18 of parent

Date

Please upload a picture of the applicant here

Yeshiva Tehilas Shlomo: 57 Ramat HaGolan Jeruslaem, Israel

Tel/Fax: 02-582-9942 Fax 610-487-0242

Email: admissions@yeshivats.org Website: yeshivats.org