2025-2026 Registration Form
The Jewish Academy 2025-2026 Registration
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Family Information
Family Last Name
*
Name of Family Rabbi (Put N/A if none)
*
Family Synagogue Affiliation (Put N/A if none)
*
Primary language spoken at home:
*
Please Select
English
Hebrew
French
Spanish
Russian
Other
Was mother born Jewish?
*
Please Select
Yes
No
If no, please provide proof of Jewishness:
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Parent/Guardian 1 Name:
*
First Name
Last Name
Parent/Guardian 1 Phone Number:
*
Please enter a valid phone number.
Parent/Guardian 1 Email:
*
example@example.com
Parent/Guardian 1 Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Parent/Guardian 2 Name:
*
First Name
Last Name
Parent/Guardian 2 Phone Number:
*
Please enter a valid phone number.
Parent/Guardian 2 Email:
*
example@example.com
Paren/Guardian 2 Address:
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Number of Students Registering
How many students are you registering?
*
1
2
3
4
5
Student Demographic Information
Student #1 Registration
*
First Name
Last Name
Grade Entering
Student #1
Early Childhood (3 Year Old)
Pre-Kindergarten
K
1
2
3
4
5
6
7
8
9
10
11
12
Student #1 Birthday
*
-
Month
-
Day
Year
Date
Student #1 Previous School
*
Student #1: Upload a current photo
*
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Student #1: Does student need ESOL (English Language Support) services?
*
No
Yes
Student #1: If yes, what is their level of English?
Please Select
Level 3: Child can speak and read in English with limited support
Level 2: Child can speak but cannot read in English
Level 1: Child cannot read or speak any English
Student #1: Does student currently have an IEP (Individual Education Plan) or special education needs?
No
Yes
Student #1: If yes, upload IEP
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Student #1: Describe special educational needs?
Student #2 Registration
*
First Name
Last Name
Grade Entering
Student #2
Early Childhood (3 Year Old)
Pre-Kindergarten
K
1
2
3
4
5
6
7
8
9
10
11
12
Student #2 Birthday
*
-
Month
-
Day
Year
Date
Student #2 Previous School
*
Student #2: Does student need ESOL (English Language Support) services?
No
Yes
Student #2: If yes, what is their level of English?
Please Select
Level 3: Child can speak and read in English with limited support
Level 2: Child can speak but cannot read in English
Level 1: Child cannot read or speak any English
Student #2: Upload a current photo
*
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Student #2: Does student currently have an IEP (Individual Education Plan) or special education needs?
No
Yes
Student #2: If yes, upload IEP
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Student #2: Describe special educational needs?
Student #3 Registration
*
First Name
Last Name
Grade Entering
Student #3
Early Childhood (3 Year Old)
Pre-Kindergarten
K
1
2
3
4
5
6
7
8
9
10
11
12
Student #3 Birthday
*
-
Month
-
Day
Year
Date
Student #3 Previous School
*
Student #3: Does student need ESOL (English Language Support) services?
No
Yes
Student #3: If yes, what is their level of English?
Please Select
Level 3: Child can speak and read in English with limited support
Level 2: Child can speak but cannot read in English
Level 1: Child cannot read or speak any English
Student #3: Upload a current photo
*
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Student #3: Does student currently have an IEP (Individual Education Plan) or special education needs?
No
Yes
Student #3: If yes, upload IEP
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Student #3: Describe special educational needs?
Student #4 Registration
*
First Name
Last Name
Grade Entering
Student #4
Early Childhood (3 Year Old)
Pre-Kindergarten
K
1
2
3
4
5
6
7
8
9
10
11
12
Student #4 Birthday
*
-
Month
-
Day
Year
Date
Student #4 Previous School
*
Student #4: Does student need ESOL (English Language Support) services?
No
Yes
Student #4: If yes, what is their level of English?
Please Select
Level 3: Child can speak and read in English with limited support
Level 2: Child can speak but cannot read in English
Level 1: Child cannot read or speak any English
Student #4: Upload a current photo
*
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of
Student #4: Does student currently have an IEP (Individual Education Plan) or special education needs?
No
Yes
Student #4: If yes, upload IEP
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of
Student #4: Describe special educational needs?
Student #5 Registration
*
First Name
Last Name
Grade Entering
Student #5
K
1
2
3
4
5
6
7
8
9
10
11
12
Student #5 Birthday
*
-
Month
-
Day
Year
Date
Student #5 Previous School
*
Student #5: Does student need ESOL (English Language Support) services?
No
Yes
Student #5: If yes, what is their level of English?
Please Select
Level 3: Child can speak and read in English with limited support
Level 2: Child can speak but cannot read in English
Level 1: Child cannot read or speak any English
Student #5: Upload a current photo
*
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Student #5: Does student currently have an IEP (Individual Education Plan) or special education needs?
No
Yes
Student #5: If yes, upload IEP
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Student #5: Describe special educational needs?
Payment
Total amount to be Zelled to rcalbert@tjaonline.com upon completion of this registration form:
*In the event your child is not accepted to The Jewish Academy, your full Registration Fee will be refunded.
Terms and Conditions
*
Signature
*
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