Download the paper form, or submit the online form below.

Hebrew School Registration Form 2021-2022

Student Information
Name
Date of Birth
MM slash DD slash YYYY
Hebrew Name
Public school grade (as of 9/1):
Student Information - 2nd Child
Name
Date of Birth
MM slash DD slash YYYY
Hebrew Name
Public school grade (as of 9/1):
Student Information - 3rd Child
Name
Date of Birth
MM slash DD slash YYYY
Hebrew Name
Public school grade (as of 9/1):
Parent Information
Mother
Father
Address
Address (if different)
Home Phone
Home Phone
Work Phone
Work Phone
Cell Phone
Cell Phone
Email
Email
Names of those authorized to pick up students, other than parents
(Come in school to sign child in and out of class and must be able to provide ID)
Name & Relation
Phone
Name & Relation
Phone
In case of emergency, notify:
Name & Relation
Phone
Name & Relation
Phone
Family Physician
Phone
I hereby grant permission for Congregation Beth David Hebrew School to call our family physician in the event of an emergency if I cannot be reached. If my family physician cannot be contacted, the school may call another physician, or take my child to the South County Hospital Emergency Room.
Photographs
I hereby grant permission for my child’s (children’s) photographs to be taken and used in school publicity.
About Your Child
The following information is solely for the purpose of helping us better serve your child and keep your child safe during school. This information will be held in the strictest confidence and is for school use only.
Does your child have an IEP (Individualized Educational Plan) and/or IHCP (Individualized Health Care Plan) at his/her public school?
- IEP only
- IHCP only
- Both
Special Health Care Needs