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Parents Registration

Online Registration Form

Full Name*
First NameLast NameHebrew Name
Birth Date*
MonthDayYear
Gender*
Current Grade*
Entering Grade*
Home Language*
Is the student fluent in Hebrew?*
Is the student fluent in English?*
Is the student fluent in Spanish?*
Previous Schools Attended and Years*
Parents' Information
Father's Name*
First NameLast NameHebrew Name
Mother's Name*
First NameLast NameHebrew Name

Address*

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Address #2

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Home Phone Number*
- Area CodePhone Number
Mother's Cell Phone*
- Area CodePhone Number
Mother's E-mail*
Father's Cell Phone*
- Area CodePhone Number
Father's E-mail*
Emergency Contact*
Phone Number*
- Area CodePhone Number
Relationship to Child*
Child's Siblings and Ages
Health Information
Family Physician*
Phone Number*
- Area CodePhone Number
Allergies*
YesNo
Please Specify
If your child takes any medication, please specify
Please indicate if your child suffers from any illness
Does your child have any special diet or nutritional needs?
Parent's Signature*
Write your initials
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