SFJA New Student Information

SFJA New Student Information
*

Information Request / Intake Tour
Student's Name *

First Name Last Name
Student's Hebrew Name *
Student's Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Student's D.O.B. *

Month Day Year
Date of birth
Current Grade Attending *
Student's Cell Phone Number

Area Code Phone Number
Home Phone Number

Area Code Phone Number
Student's Email
example@example.com
Upload Picture of your child *
School Attended *
School Phone Number *

Area Code Phone Number
Grade Entering *
Math Grade Level *
Current grade level
Reading Grade Level *
Current grade level
Judaic Grade Level *
Current grade level
Past Expulsions / Suspensions *
If yes, Please list: *
Health Information
Does Student Have a IEP or any outer test results *

Yes No
Upload all test results, recommendatios, including IEPs. *
Does your child require any additional services *

No PT OT Speech ABA
If yes, Please list: *
Does student have any official diagnosis? *
If yes, Please list: *
Does student have learning difference or challenges? *
If yes, Please list: *
Does your child have any allergies? *
If yes, what is your child allergic to? *
Does your child carry an EpiPen and/or Inhaler? *
Toilet Trained *

Yes No
Parents Information
Parent's Marital Status *
Student lives with *
Scholarships *
Mother's Name *

First Name Last Name
Mother's Hebrew Name *
Mother's Cell Phone Number *

Area Code Phone Number
Mother's Email *
example@example.com
Father's Name *

First Name Last Name
Father's Hebrew Name *
Father's Cell Phone Number *

Area Code Phone Number
Father's Email *
example@example.com
Congregation with which family is affiliated Name of Rabbi / Shul *
Is either the mother or father not born of Jewish faith *
Which parent was not born Jewish *
Is the conversion completed yet? *
Name of Rabbi who did conversion *
Rabbi Phone Number *

Area Code Phone Number
How did you hear about us? *
Appointment - Please select a date that's best for you and the office will contact you to confirm if that date/time is possible.
Terms and Conditions *
Mothers Signature *

Clear
Fathers Signature *

Clear

My Products *

New Student application fee $ 100.00

Total $ 0.00

Credit Card
First Name	Last Name
Credit Card Number	Security Code
Expiration Month	Expiration Year
Billing Address
Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Should be Empty:

SFJA New Student Information

Health Information

Parents Information